Case study 9.6: Julian

I’m not sure if I remember exactly when I became a self-injurer, I believe I was around twenty-two years old. I don’t look back and see my self-injury as a time when I fell from emotional stability into turmoil. I had always had a lot of personal issues and depression, though I hadn’t always identified those things in myself; you only experience being yourself, so you have nothing to compare with.

Usually when the need to hurt myself was greatest, I would find myself in a place where time would seem to slow down and I would stare blankly at things, feeling tense and confused. The most certain way to get out of this state was to hurt myself, and I remember resenting that because I didn’t feel in control.

To help myself stop I joined an online chat room and read some things. I learned some techniques, like holding ice cubes while thinking of a time and place where I felt safe. Some tricks I discovered for myself: music would help when time seemed to slow, and the scent of sandalwood oil could sometimes snap me out of things. At times when I failed and had to have the peace I knew self-harm would bring, I tried not to use my failure as another way of undermining my confidence. A lapse needs to be only a lapse.

Keeping faith in yourself is important. I always had an ‘inner critic’ who would at any moment throw vicious names into my stream of thoughts. During a more enlightened moment, I recognised this inner critic and even named him, using a silly name to help belittle him. I found it an especially useful skill: when undermining words would enter my head, I would ask (sometimes out loud) what that part of my brain was accomplishing while the rest of me was trying so hard to get on with my life. It sounds strange, but I believe it was a significant step in “choosing whose side I was on” and believing in myself.

Self-injury phases came and went. To begin with, I tried to distance myself from the notion [of self-injury] whenever it wasn’t an immediate presence, but I think this was a mistake. Something changed in me when I became a self-injurer, and simply forgetting about it was not going to change things back. When a self-injuring phase came upon me, I would find myself as unable to deal with it as when I first started. So I stopped running away from it, and let myself feel less afraid of identifying myself as a self-injurer. Even this can help; sometimes we need physical evidence to validate our feelings, and just as you can learn to use a fading scar as a substitute for a cut, even the memories of self-injury can help you know that your feelings are real. Fighting the urge to self-injure takes a lot of energy, but it’s never wasted. Even when you fail, every extra five minutes of enduring the urges before giving in is important.

In the end, I fought urges by gaining more understanding of why I wanted to self-harm. In my case, my brain had learned a trick of denying emotions when they were unacceptable to me. Rather like the question of a tree falling where nobody can hear it, I had decided that if something hurt me and I was the only one to know it, then perhaps it had never happened after all. I realised that when somebody close to me acted in a way that was hurtful, I tended to ‘forget about it’ and act like it had never happened. The emotions would form a confusing conflict inside me, a collection of ongoing negative stimuli with the labels cut off. A few times during urges, a friend was there to ask me what had happened, and each time, I said that nothing had. She knew me better and persisted. After talking, she would uncover something which logically had obviously triggered me, but I would be unaware of it. After thinking it through more I would find my urges easing; I think that triggers by their nature are an emotional blind spot for me. Even something trivial, if not acknowledged and processed, can provide a strong trigger because there’s been no chance for my brain to dismiss, forgive, or explain it on a rational level.

I’ve been asked by a few self-injurers what it was that stopped me from getting urges to hurt myself, and the answer is that I never did. Self-injuring thoughts and urges are something I’ve learned to be happy with as a part of me. I would go as far as to say I would feel lost without them, because they are now a part of the spectrum of emotional signals that I get. I have learned to recognise them as a secret signal that there is an emotion I have blocked or not accepted. Once I look for it and consider the things that might have triggered me, I’m able to go back and respond more rationally to the original stimulus. That’s when the urge to hurt calms. It’s not intuitive, thus, it is sometimes hard for me to remember when in the panic of a serious urge, but with enough practice, it has become more natural.

I am now a 30-year-old recovered self-injurer, by which I mean nothing more official than the fact that four years have passed since I last performed an act of self-injury. I don’t worry about the self-injury returning though, because as an impulse, it never really left and I know that I won’t let myself lose the skills I need to be who I am. As fate would have it, I married another recovered self-injurer. We talk about it sometimes, and it can feel strange and distant, but at the same time it feels no odder than a lot of other bits of growth and learning you go through in life.

Summary of Julian’s story

Case study 9.7: Morven

It’s hard to imagine where I was just a few years ago. It seems so far away, yet it still feels close in so many ways too. I guess it just strikes a few nervous chords within me when I remember and think about where I was back then. . .

In short, I hated myself. Actually, I loathed myself. I couldn’t possibly understand how anyone could love or care for me and didn’t trust anyone who told me they did. It was a lonely existence. I felt abandoned. I was afraid that no one would understand what I had experienced and how it affected me. I was always confused. I felt tormented, angry, and hurt. I hated the thought of not knowing how I was going to feel from one day to the next. I felt guilty for hurting, guilty for hurting those I loved, and for being angry and feeling hatred towards those who had hurt me, but still loved. I felt misunderstood, and analysed and personalised everything – every small thing that went wrong was my fault. I felt empty at times – or it seemed as if I was trying to feel empty, to prevent myself from feeling anything else. Nothing gave me pleasure, but I was an expert at masking that.

Self-harm was my retreat; a way of suppressing and retracting into a world of my own – a world I could control – my way of easing the guilt and the hurt that was within. It was also my way of punishing myself too – punishing myself for the person that I was, and for the things that had happened. For a time self-harm would make me feel human again, but soon the cycle of guilt returned to haunt me.

It’s been over four years now since I self-harmed. I wish I could explain how I managed to stop the cycle, and bottle it, so everyone could use the formula. It hasn’t been a smooth ride, and admittedly, I have times even now when I want to turn to the razor blades again just once more, but I don’t. Why? Because I believe that ‘once a self-harmer, always one’ and once is never enough.

The thought of letting go of something that seemed so intrinsic in my life was a terrifying one. It took many months to achieve. For some it takes years – but for us all, it is a constant battle. I promised I would quit for friends, but soon realised that in order to really quit I needed to make the conscious effort to quit for myself.

When coming out of any addiction, you are counselled to give up everything that is associated with it. This phrase springs to mind, ‘What holds my attention, holds me’. And so I did. I quit all those associations concerned with self-injury. It was hard (and it’s not for everyone), but I knew it was something I had to do. Through taking these small, yet huge steps, I was able to re-evaluate where I was, what my priorities were, and who I wanted to be.

Throughout my relatively short life, I have continued to ask questions such as ‘Why do bad things happen to good people?’ and ‘Why do people have to live through other peoples’ actions?’ Along with those small steps, I also realised that maybe we have to learn about unanswerable questions and inconsolable answers. Many people think they have the answers and perhaps they have some, but many haven’t ever had to ask the questions and that makes all the difference. I guess I began to acknowledge that what actually makes quitting difficult is the process of confronting and solving those issues that underpin the action of self-harm. In some cases it’s not necessarily the issues or experiences in question, but more the feelings they invoke, and the pain they involve that needs to be acknowledged. Fear is a strong emotion. It caused me to ignore, try to forget, pretend that things never happened, never existed. I tried for most of my life to escape my past, when in reality, what I really needed to do was suffer through it. I needed to confront the past and my fears head on. When I decided to quit self-harming, I also began to face my fears and truths of the past. I began to get stronger, and with this newfound strength, strived even harder to maintain my commitment to not self-harm.

Over time, I am now able to look at the past without so much fear and say to myself, ‘Yes, it happened, they affected me, but now I have moved on.’ I can say that I have actually gained from all my experiences and in some way, I hope to be able to touch others through them. I now look at the future with optimism and know I actually have one – that I can look to the future and be happy. I am happy.

Over the past four years I have continued to develop my career and have gained confidence in who I am and what I can be. I now have positive goals to further my career even further. Set-backs, whether on a personal level or professionally do not affect me the way they used to – sometimes I still feel the urge to self-harm, but I have never succumbed. I have also found the beauty of loving someone and being loved and accepting that love and acknowledging they love me for who I am. Sometimes that knowledge overwhelms me, but most of the time I feel happy and at peace. So now, I not only do not self-harm (though admittedly it is a hard battle at times) for myself, but also for my long-term partner and for my future children and beyond every other reason for not self-harming they have made all the difference.

Summary of Morven’s story

Case study 9.8: Kate

The statement below is from an email Kate sent me in September 2004 ‘I’m still doing really well; no depression, no self-injury, a good set of supportive friends and I’m just about to finish my degree and get a job (fingers-crossed!). I’m pleased to say everything finally seems to be going right for me.’

Warmed by her words and achievement, I invited Kate to write a piece about what turned things around for her. These are her words:

It’s difficult to say what happened, I think probably a number of things contributed to me stopping self-injuring and turning things around.

Well, one day I actually made a conscious decision not to self-injure. Oh and it was so difficult, but I just didn’t allow it to be an option. At first, I spent a lot of time finding distractions, things that would just take my mind off self-injuring for a while until the desire passed: taking long walks, painting, writing, making jewellery and restoring vintage dolls (I’ve even made a little money with the last two!). Distractions are good, but ultimately they’re not a fix, I think there has to be a more fundamental change; a change in thinking, so that the first thing you think when you feel bad isn’t ‘self-injury’, but something else, something more healthy.

I found just being able to recognise the emotions I have has been important. That sounds so simple, but I think before I was lumping things together and everything made me feel either ‘good’ or ‘bad’. Now, I’ve come to know the sorts of situations and emotions that trigger me – anger, stress and frustration – and I just stop myself. I recognise what’s going on in my head and that’s part of the problem dealt with. I’ve learned to recognise when I’m about to drift off and out of control.

Also, I stopped trying to cope on my own. I made the most of support groups, I moved in with my parents and just let them look after me so I didn’t have to worry about running a home and all the responsibilities that go with that and I accepted that I wasn’t well enough to work. I took advantage of all the help that friends and family were offering, and focused on staying alive and getting better.

I haven’t self-injured in over four years, but I am still a member of a support group and I think that has been very important to me – to know that there is support available to me if I ever need it and to know that I’m really not alone in this.

Now, although things aren’t perfect they are pretty good . . . and I am no longer scared of wearing short sleeves.

Summary of Kate’s story

Life after self-injury by Rae

Life after SI is one where SI no longer has control over you. Yes, there is a feeling of loss of control and a loss of identity when you first stop injuring yourself, but that is temporary. When SI is removed from your life, you are forced to find other means of self-control and other means of identifying who you are. The issues don’t go away, but you find better ways of dealing with them. It is liberating, to be able to kick SI to the curb and say, ‘I don’t need you.’ My life after SI is one where I am stronger, prouder, healthier. SI has no control over me.

Key points

• Self-harm was a behaviour Juliet learned in hospital while being treated for anorexia.
• A link between disordered eating and self-injury is evident in four case studies: Juliet’s, Caroline’s, Amy’s, and Emma’s.
• A progression route from self-harming behaviour in their childhood to self-injuring in their teens is apparent in Amy’s and Emma’s case studies.
• Caroline and Julian started self-injuring as adults.
• A negative self-concept (self-dislike, self-loathing, self-hate) was evident in several case studies.
• Motivations to self-harm included repulsion of one’s body, tension building up, emotions welling up, screaming silently inside, anxiety, depression, lack of identity, very low self-worth, being in a ‘trance-like’ state, confusion, to gain self-control, to ease guilt and hurt, to self-punish, unable to express the emotional pain.
• Functions served by self-harm included providing a release for anger, more able to cope immediately afterwards, punishing undeserving self (disordered eating etc.), being able to see one’s mental anguish (cutting), brief interval from emotional pain, to keep functioning, physical validation of one’s feelings, and to make one feel human again.
• Time stopped self-injury: Amy (almost 30 years); Emma (5 years); Morven and Kate (over 4 years); Julian (4 years); Paige (26 months approx.).

What helps those wanting to recover?

• Having a counsellor that does not judge you or tell you to stop self-injury.
• Looking beyond the injuries and appreciating the person as she/he is for who he/she is.

What helps recovery?

• Making a conscious decision not to self-injure.
• Making the conscious effort to quit for yourself – not for others.
• Accepting that self-injury is going nowhere.
• Focusing on yourself, rather than self-injury.
• Letting go of the control self-injury has over you.
• Developing a range of alternative coping strategies to resist the urge.
• Caring more about yourself.
• Therapy.
• Getting support.
• Joining an online chat room.
• Educating yourself about self-injury.
• Recognising that a slip need only be a slip – not a failure.
• Awareness that self-injury thoughts and urges might be an indication of an emotion being blocked or ostracised.
• Being able to identify your emotions.
• Being able to recognise times when you are dissociating (drifting off/going into a trance-like state/staring blankly into space).
• Changing your thinking so that when you feel bad, self-injury isn’t the automatic route to feeling better.
• Confronting and solving the issues that underlie the need to self-harm.