Healing Self-Injury

I’ve missed writing to this blog. Got caught up with work and busy holidays and the time has just flown by. But I’ve got some time now, stranded in the Detroit airport, trying to get home after a work trip. This job was interesting – I was asked to tape two TV episodes for a series on mental health in Missouri. One episode’s topic was trauma and trauma-informed care; the other was self-inflicted violence (SIV). As much as I despise cameras, I thought this was a great opportunity to talk about what I believe and hope for when it comes to promoting understanding and healing for people with psychiatric labels, especially those who live with SIV. I really enjoyed spending time with the host of the program, Tom Parquette. The more we talked, the more I realized that we shared a vision of change. I hope that our dialogue is useful to people.

Yet sitting here, thinking about the conversations that were taped, I realize that I wish I had made stronger statements about the horrific impact of coercion in the psychiatric system. While Tom often urged viewers who might be struggling to seek help, I would occasionally caution people to be wary of the potential dangers that come from seeking help when you live with self-injury. Not all help is the same. Some of us have found hope and understanding from mental health professionals. But many of us have also been greatly harmed by people with the same credentials. When you live with SIV, you run the risk of being coerced into “treatment” – the belief that, since you live with SIV, you need to be acted upon “for your own good.” And it is not uncommon for “treatment” to consist of being locked away or tied down (and then being billed for it). While the goal of my work is to help create a system where trauma-informed care is available to anyone who wants it, the majority of the mental health system currently uses coercion in some form.

So what is the harm that comes from being coerced? As I thought about what I wanted to say I remembered the writing of psychiatric ex-patient, activist, and mentor Rae Unzicker’s words in her piece History, Principle, and Definition of Consumer-Direction and Self-Determination (published in The International Center for the Study of Psychiatry and Psychology Newsletter, Spring 2002, pg. 4-8). These are the words that I wish I had with me during the taping of the shows. It’s too late to say them to the cameras, but I am glad that I can share them with you.

In the article, Rae boldly spoke about the many ways psychiatrically labeled people are patronized and managed, even in the name of “empowerment.” While discussing the evolution of the consumer movement she forcefully brought out the reality that freedom cannot be possible as long as coercion remains an integral part of psychiatry. She made us consider that, while consumers can promote many changes in the system, of what merit are they when force remains? She wrote:

Involuntary treatment is the battleground – not better services, more money for SSI, managed care, or any of the other important issues we discuss politely.

Because it is the fear of civil commitment that drives each of us… You don’t get upset – and you certainly don’t get your parents upset. You become in a thousand little ways more cautious, less expressive, blander, less alive – so you don’t stand out, so no one notices you. And this is the beginning of the encroachment, when spiritual death begins. It is a day-to-day tyranny, a slow wearing down of the spirit.

No longer do you trust your own bright clear inner voice. No longer do you know what’s best for you. But someone else does.

Her words describe some of my experiences in the psychiatric system when I was being “treated” against my will. As a result I sometimes, after all these years, fear speaking my mind, whether in front of a camera, an audience or a friend, because I am afraid that someone will lock me away again. One look at my scars, no matter how old, and they might be able to get away with it. Is this likely to happen? No. But is there a remnant of fear deep in my gut? Yes. I thought I’d share it with you. That will lesson its power and next time, when I’m in front of the cameras or the audience or the friend, I will speak a bit more strongly and clearly. I will agree that people who live with SIV should have access to, and be able to ask for, all the help possible, but that there remains potential danger in the asking. I will remind myself and others that we must continue to create places of healing for ourselves and each other that do not depend on any organized system of care. Care comes from our own and each other’s understanding and tender hearts. Hope that you are taking care of yours and I thank you for listening to mine.

I wanted to share the wisest sentence I have heard about healing from SIV. This pure and simple sentence is the answer I use when I get asked “How can I make myself stop cutting, burning, punching myself?” I say the same when I am asked by friends and family of people who self-injure, or mental health or criminal justice professionals, how to “end self-mutilation.”

Most people, even some who live with SIV, focus almost completely on making SIV go away, as if it were an evil to be eradicated, after which there would be peace for all. This attitude is understandable, yet it has caused incomprehensible suffering for many who have lived with SIV. When you only care about making a behavior stop you will do anything you feel you can to make it stop. So the mental health community, and the general public as well, have accepted the need to “force” people to stop SIV. What does this force look like? Simply stated, coercion is never pretty. Nor is it effective. Force, most often, replicates previous trauma that the person who is living with SIV is trying to cope with.

If you keep healing, you will reach a point where you no longer need SIV. That will be your time to live without it. In the meantime acknowledge that it serves as well as harms, and nurture compassion for yourself while you are on the journey. SIV does not need to be forcibly stopped. SIV often helps people cope when suicide seems the only possible solution (many people don’t understand this and equate SIV with suicide attempts). I think it is crucial that we find things to live for, whether we self-injure or not, as we struggle with the pain of our histories. Many of us go on for our children or other groups of people we care about. Some turn to the arts or nature. We can discover things we are passionate about to balance the pain and the fear that we live with. And we can find others who share the journey. It helps to have a safe place to discuss all this, and that is how I hope this blog feels – like a safe place. What is it that keeps you going?

My thanks to those who have posted comments to this blog.  It is beginning to come alive to me, this new way of creating a community of people who live with SIV and our allies.  I am still new to this format, but the posts I have read remind me of The Cutting Edge, the newsletter that will soon be coming to a close.  Many of your words touched places in my heart.  Historically, the topics of repulsion/revulsion towards those who live with SIV, the idea that SIV has no purpose and must be stopped at all costs, and the link between deep and profound trauma and the need for SIV have arisen repeatedly in the history of The Cutting Edge.  To see these topics addressed in your posts made me think that we are beginning to create our own community where we can discuss our lives with SIV without fear of repercussion or judgment.

Rae questioned if many people are repulsed by or afraid of those who live with SIV.  People often have intense, judgmental and negative reactions to SIV.  It takes courage and effort for others to deal with their own intense reactions and assumptions about self-injury and learn to understand the purpose SIV serves and what helps us heal.  These allies are wonderful.  While some of them do exist in the world of mental health care providers, they are not easy to find.  Therefore, much of the time when we turn to help from the worlds of psychiatry and psychology we tend to find more trauma, little understanding, and urgent demands that we stop what, to us, feels necessary.  As Shade and others wrote, many of us fear the ending of SIV in our lives.  Of course this makes sense as it has helped us get through incredibly difficult times.  Drugs won’t help us learn how to let our feelings flow through us, help us understand how profoundly trauma effects us, nor give us the hope, community  and wisdom we need to heal and live lives we never dreamed possible.

Diane, your writing about your childhood touched my heart deeply. I do not know of anyone who has lived with SIV who didn’t have some form of trauma in their history.  Often, but not always, this has included surviving childhood abuses.  The SIV we turn to helps us manage many of the repercussions of our histories.  That is why I do not believe that attempting to simplistically make SIV “go away,” whether through drugs or any other means, is useful.  While SIV has its consequences, it also has its assets.  The drugs that are used to “stop” SIV do much of what you described - they change thinking and they change feelings.  While some people find the use of psychotropic drugs helpful in their healing, most say that being “slammed” with intense dosages of psychiatric drugs, especially the antipsychotics, leaves them feeling numb, “dead” inside, and inhuman.

Finding help from people who understand trauma is often difficult, but worth the effort.  There are some professionals who understand and are helpful (Sidran’s help desk might be a useful place to begin a search), but there are also other supports available.  People who live with or have healed from needing SIV can offer enormous wisdom and compassion.  The Cutting Edge newsletter was begun nearly 18 years ago to create a community of survivors, people living with SIV, and their allies.  It is my intention that this blog and the Healing Self-Injury web site do the same.  I think our community has begun to create itself.  Thanks to all for writing.

Lately I’ve been playing with a question I was asked after a workshop I presented on SIV. A psychologist stopped to talk after the training and was arguing the need to have the right to restrain people who self-injure. I gave him my thoughts about how retraumatizing people who already are living in a world of pain serves no one, including the staff of the institutions in which restraint and seclusion (tying people down to beds and/or locking them in padded rooms) remain prevalent He remained adamant that all SIV must be stopped, that clinicians should not have to tolerate anyone who continues to self-injure. He proposed using psychiatric drugs to achieve this as well, but did admit that there are no drugs, used appropriately, that achieve the result he was after.

It was his next statement that I found interesting. He was adamant that if a psychiatric drug could be created to take away the need to self-injure, that all the people living with SIV would be more than interested in taking it forever. I told him that I didn’t think this to be true, but that I would ask the experts, the people who live with SIV. I believe that SIV is not “all bad” as this psychologist was presenting, that SIV serves a purpose in many people’s lives that helps them cope with the aftereffects of trauma and the struggles of healing. While living with SIV certainly has its down side, it also has a purpose. And as people come to understand the trauma in their histories the need for SIV abates as healing progresses. A drug that would solve the problem so simply would likely do what so many of the other drugs used previously have done, make a person so numb that they might lose touch with their pain and struggle but also become so numbed as to not feel truly alive. I presumed that the price of permanently drugging oneself out of the need for SIV would be too high to pay. I believe that SIV fades away as we learn to understand, experience, and release the pain, rage and disconnection that it manages. We can learn a great deal about ourselves from the urges to self-injure.

But he made me think and now I am curious. Any thoughts out there?

Sometimes when you meet people who touch both your heart and your soul you carry them around in your thoughts for quite a while.  Though your time with them might have been brief, it seems that the experience changes you at a great depth.  I have been holding very warm thoughts about four people I met this past July and I want to tell you about them.

A few months ago I spent two days teaching about SIV at a state mental hospital for children and adolescents in Virginia.  The hospital had decided to make an intense effort to reduce the amount of restraint and seclusion (being locked in a small room and/or tied down to a bed) being done to the young people there.  As SIV is one of the most common reasons that people get restrained or secluded, I was hired to teach some of what I know and to work with the staff.  I had the opportunity to meet with many people, including administrators, psychologists and nurses, and direct care staff.  I met many concerned people who struggled greatly to understand what SIV is about and how to help.  Yet the people I carry around in my heart today are the four young people I had the chance to meet for an hour.  They were currently patients, living behind the locked doors of that facility.

I was led onto a unit and found four young people seated at a table.  I introduced myself, told them why I was brought to the hospital, and asked them if they would be willing to help me.  They seemed surprised to be given a choice – I had forgotten how controlled are days behind locked doors.  I asked them to listen to a short version of what I had taught the staff and tell me if they agreed with what I was saying and offer ways I could improve.  After all, it was the environment that they were living in that I was trying to change.

They could not contain their surprise and disbelief when I let them know that I had lived with SIV and was a scarred person myself.  One young woman stared at my long sleeves, so I rolled one up so that she could see the old, faded, but permanent scars.  What happened then touched the core of my heart.   She reached out and touched my scarred arm, tenderly.  What a different reaction than most, no?  These people weren’t repulsed, they recognized our kinship.

With that we talked of our lives with SIV, our histories and what had brought us such great pain, fear and rage, and our hopes for the future.  We shared a few tears, quite a few laughs, and a hug or two.  The hour flew by and it was soon time for me to go back to the meetings with the staff people.

What the staff and I talked about is for another post.  What I am thinking about as I remember those four remarkable people is how important it is to feel accepted and understood.  At one point I asked if they knew of any other slang names for people who live with SIV.  I said I thought it was most common for us to be called “cutters.”  They let me know that the current slang term has changed and that they were considered to be the “emo kids.”  The “emo” stood for “emotional hardcore.”  They were, of course, seen to be some of the most difficult patients there.

So they are the “emo kids.”  When I was about to leave our group I thanked them and said that I would remember my time with the emo kids, how much I appreciated having met them.  They said that they had also enjoyed their time with me, that it felt unusual feeling  understood by an adult.  Now that I am nearing my 50th birthday I recognized I must look really ancient to them.  So I asked them how, since the term “emo kid” would not apply to me, I should define myself.  It was decided that I am an “emo granny.”  What an honor.

Hello Everyone,

I am beginning to get used to writing this blog and intend to post more frequently. First, I want to thank all of you who sent comments to the previous two posts. They are greatly appreciated. We are beginning to create the community I’ve been hoping for, especially as The Cutting Edge is coming to a close (the final issue of the newsletter is still being written and should be mailed in the next 4 weeks).

So many of your comments raised questions about the difference between healing from self-injury and simply stopping the behavior. Some of you are living with self-inflicted violence (SIV) while others are concerned for those you care about. While I hope that you access the resources on the web site (I’d be greatly interested in your opinions), I have a few thoughts to share.

From the past 20 years of speaking with people who live with, or have healed from needing SIV, the teaching that I do, and my own experiences, I believe that people heal from the need for SIV in many ways. The healing journey is a personal one, yet I hope everyone has support along the way. Support is one of the goals of this blog and web site. Healing cannot be mandated. SIV, while obviously having its consequences, also serves some crucial purposes in the lives of the people who need it. When there are no (or few) other options, SIV can even help someone stay alive in the moment. For many people who live in such emotional pain that they consider suicide as a solution, SIV has been a temporary salve to that pain. The goal is to attend to the profound discomfort that underlies the need for SIV while expanding the options one has for dealing with life’s very intense struggles.

A history of trauma underlies the need for SIV. SIV is one of the ways people cope with the aftereffects of abuse, loss, neglect, disaster and other forms of trauma (trauma can be obvious or subtle). It helps people get by, to attend to their intense emotions, disconnection, and difficulty with expression that trauma brings. As we heal from the trauma, we heal from the need for SIV. While some people find that making an actual decision to stop SIV has been very helpful, others heal from the need for SIV without any direct focus on it. We are each an experiment of one, yet there are commonalities in the experiences of those who have talked to me about their healing over these past 20 years. Coercion and shame are never helpful. Understanding and acknowledgement of one’s strengths are. I have delved into these ideas at lengths and invite you to read the articles on the web site and offer your opinions.

One comment I need to address is the one questioning whether I “support” SIV. This is not an uncommon question about my work, especially in the professional trainings that I do. Because I do not condemn SIV it might appear that I support it. I do neither. SIV serves a purpose in the lives of the people that need it. It also has its consequences. I do not find judging SIV, nor the people that live with self-injury, useful. I have been privileged to witness the healing of many of us who have needed SIV and I have found that few of us truly salved the old wounds (of trauma as well as SIV) in an environment that was judgmental. My SIV has left me with scars, yet it also is one of the ways I coped with what felt intolerable, inexpressible and unbearable. While SIV is, by definition, an act of violence, for me it was an act of self-defense. Now, many years down the road from picking up the razor or the hammer or the match, I can acknowledge that it was one way I coped during some very brutal days and years. It was part of my survival as I began to learn about healing and, now, living. I am so glad I made it to this point!

I have been busy traveling lately, speaking to various groups of people about why some of us live with self-inflicted violence (SIV), and what helps people heal.  What I have talked about more and more as I do these trainings is the awareness that all people do harmful things at times.  While it may not be as obvious as the cuts, scratches, bruises or blisters that come from SIV, other forms of self-harm are more dangerous, yet not as strongly reacted to as SIV.  Some forms of self-injury are quite subtle, and might even be societally supported, such as overworking and overspending.  I have found it hopeful to have all people consider the various ways that they have “harmed” themselves, why they did so, and if they want to change their self-harm or not.  This has been a most useful tool in building a bridge of understanding between thsoe who live with SIV and those who do not.  The more we understand, connect, and relate to each other, the more we can help each other and ourselves.

I am adding material to the web site and invite you to look at several more publications and let me know if they are of use to you.  I am also going to look up an editorial I wrote a while ago, just on this topic of the many forms of self-harm, and post that as well.   Please let me know what you think!  We at Sidran have had recent problems with our e-mail so I apologize if you did not get through to us.  Please give us another try.

Welcome to the Healing Self-Injury blog!  This blog is dedicated to the idea of creating a place that people who live with self-inflicted violence (SIV), or those who care about them, can have to feel accepted, heard and supported.  Both the Healing Self-Injury web site and this blog are the continuation of The Cutting Edge: A Newsletter for People Who Live with Self-Inflicted Violence, a newsletter I began in 1990 and which will be ending shortly.  This is a time of transition.  While I am sorrowful to end the paper publication, I am very excited about the potential for creating a sense of community electronically.

To those of you who subscribe to The Cutting Edge, your final issue will be on its way in a month or so.  Some of what has been published in the newsletter over the past 17 years can already be found on the Healing Self-Injury web site.  There are also some recent new publications posted there that I am hoping will be helpful.   Please let me know what you think of them!