The dilemma of suspecting yet not knowing

This touching poem by Sinead illustrates the agony people go through when they have strong suspicions that they have suffered abused, without having clears memories or concrete evidence to support their suspicions.

Additional support

As demonstrated, recovering memories of child abuse can be acutely distressing for clients and additional support may be required at this very difficult time (extra sessions; permission to telephone, email, or text; a list of supportive people or organisations to contact). As a coping strategy to avoid dealing with the painful memories or in a desperate attempt to dissociate from them (prevent them from entering conscious awareness) self-injury may escalate. Pacing of therapy sessions is critical in this situation – the client needs to stay safe within the boundaries of the ‘bearable’.

The final words on the topic of recovering memories come from author and psychotherapist, Phil Mollon (1996) who concisely and eloquently sums up my thoughts:

I believe it is misleading to suggest (as much of the FMS literature does) that the idea of being abused as a child can be a comforting solution to mental distress. In my experience recovered memories do not make people feel better – at least not initially. Approaching a traumatic memory may put a person in a state of terror, with disorientation and temporary psychosis. It may provoke extreme self-harm and suicidal acts, especially cutting . . . (p.80)

Not all people that self-injure have been abused

Although well documented in the self-injury and trauma literature that child abuse features in the history of many people self-injure, as mentioned in Chapter 2, child abuse does not signify the only reason. It is also important not to assume that everyone who has suffered child abuse will automatically turn to self-injury as a way of coping. There are numerous other factors involved, for example, the level of support available at the time of the abuse (from the non-abusing parent, grandparents, friends, and teachers, etc.), the degree of secrecy involved around the abuse, the personality of the survivor, and their position in the family. Further, different individuals develop their own unique coping strategies. For instance, in a family where three girls suffered child abuse, one might turn to alcohol to cope; another might turn to self-injury, while one might appear on the surface to have come through the experience unscathed.

An overview of the reasons for self-injury

The reasons why people turn to self-injury are intricate and multi-faceted. Predisposing factors that may trigger the act identified through my work and research include:

• Childhood traumas such as sexual abuse, physical abuse, emotional abuse, rape, torture, neglect, and abandonment.
• Recovered memories of abuse, disclosures of abuse not believed or brushed aside, keeping the abuse a secret.
• Suffering rape as an adult.
• Loss of a primary caregiver through death, divorce, or separation.
• Having emotionally absent parents, feeling unsupported by or ‘invisible’ to loved ones, or lack of secure attachments.
• Bullying, harassment, abuse of power, a lack of control over one’s life, feeling powerless or trapped, exposure to domestic violence (being subjected to, or witness to).
• Growing up in a chaotic/unpredictable family environment, e.g. parent with alcohol or substance misuse problems or mental health problems in a family member.
• Communication deficiencies in the family, e.g. unspoken family rules – ‘not allowed’ to cry or express feelings and emotions, particularly negative emotions.
• Social marginalisation, stigmatisation, and social exclusion, e.g. being homeless, gay or lesbian, a refugee/asylum seeker, belonging to an ethnic minority, or being labelled with a mental illness.
• Gender identity issues and conflicts.
• Being forced into marriage against one’s will.
• Being raised in the care system or by foster parents; being adopted.
• Role reversal in the parent-child relationship (the ‘parentified’ child), i.e. the child is expected to ‘become’ the parent in terms of responsibilities, thus requiring the child to act as a buddy, big sister, counsellor, or confidante.
• Self-injury contagion, e.g. copying friends, family members, inpatients in psychiatric care, or inmates in institutional settings such as prisons or young offenders’ institutions.
• The stress of coping with imprisonment.
• Low self-esteem because of exposure to traumatic events, stressful life experiences, and/or invalidation, or rooted in fear and insecurity.
• Pressure to achieve (from oneself and/or others), perfectionism, exam stress and sleep deprivation. Not coming up to one’s own, one’s parents, or society’s expectations – never feeling intelligent enough, successful enough, wealthy enough, or good enough.
• Negative core beliefs.

Negative core beliefs and self-injury

As seen clearly throughout this book, and this chapter, many people who self-injure hold deeply embedded negative core beliefs about themselves. Negative core beliefs are flawed beliefs that are swallowed whole (often in childhood) and become interpreted as the ‘absolute truth’ about oneself. A handful of examples of negative core beliefs noted from the respondents’ testimonies include:

• ‘I am worthless’
• ‘I don’t deserve’
• ‘I am not good enough’
• ‘I was a mistake’
• ‘I shouldn’t be here’
• ‘I am bad’
• ‘I am evil’.

These negative core beliefs may lead to establishing a subset of negative self-beliefs such as:

• I am incompetent, inadequate, invisible, a nothing, unlovable, unacceptable.
• I am defective, imperfect, inferior.
• I am different, I don’t fit in, I don’t belong, there’s something wrong with me.
• I don’t count, I never get anything right, I can never fix anything, I’ll always be the underdog, I’m a loser.

Strongly held beliefs such as these lead to low self-esteem, and feelings of self-dislike, self-hate and self-loathing. They can also lead to acute emotional distress, which in turn can motivate some people to self-injure. To illustrate how low self-esteem, not feeling of worth, and not liking oneself can contribute to self-harm, let us look behind the glamour, and public image of a much loved, much admired, much talked about and sadly missed woman who is known throughout the world.

Case study 6.4: Princess Diana speaks out about self-injury (BBC, 1997)

In 1995, the previously taboo and private subject of self-injury suddenly became a very public issue when, prior to her tragic and untimely death on 31 August 1997, Princess Diana, admitted in her legendary BBC Panorama interview that she had hurt her arms and legs. Prompted by interviewer Martin Bashir, she courageously confessed to the world, that ‘you have so much pain inside yourself that you try and hurt yourself on the outside because you want help.’ Reasons she gave for hurting herself included not liking herself; feeling ‘ashamed’ because she could not ‘cope with the pressures’, and not feeling listened to. She also intimated that it was a non-verbal way of communicating her anguish – in other words, a ‘silent’ cry for help.

Diana also revealed in the interview that, albeit it out of character, she experienced post-natal depression after the birth of William, at which time she was ‘openly tearful’; became labelled ‘unstable’ and ‘mentally unbalanced’ – tags that regrettably she felt stuck to her ‘on and off over the years.’ She talked too about suffering for several years from the eating disorder bulimia (bingeing and vomiting) which she described as being ‘like a secret disease’, and which she considered was due to having low self-esteem and not believing she was a person of worth or value. She described what she got out of her ‘eating binges’ as a temporary feeling of comfort – ‘like having a pair of arms around you’, but how this quickly changed into self-disgust ‘at the bloatedness of your stomach’ accompanied by a need to ‘bring it all up again.’ It served as an escape mechanism, which worked for her at that time.

Cause and effect

It seems that the strain of endeavouring to present a public image of ‘OK-ness’ and trying to hold everything together so as not to dishearten the public exacted a high toll on Diana, especially when behind closed doors problems in her marriage were causing stress and anxiety.

What Diana needed

Diana admits that she was crying out for help, perhaps in the only way she knew how, via hurting herself and her eating distress. However, what those around her saw, or chose to see, were the behavioural manifestations of Diana’s distress, not the cause of it. They failed to acknowledge the pain caused by the problems in her marriage, of not having time and space to adapt to her numerous roles, of feeling unsupported and longing for human comfort (praise, validation, kind words, a hug or cuddle), some of which she got from an adoring public, but not from those who she most wanted it from.

Diana’s motivations for hurting herself echo those of many other people whose words you will read in this book – low self-esteem, not feeling of value, not liking herself, intense emotional pain, feeling unable to cope, shame, and not feeling heard.

Negative self-beliefs and perfectionism

Negative self-beliefs distort self-perception, and can lead to perfectionist thinking, for example, ‘if I never make a mistake, if I am always compliant, if I put everyone else’s needs before my own, and if I don’t say “no” to other people’s requests, perhaps people will love and approve of me, or maybe they will stop criticising or judging me.’ Perfectionism is a common trait found among people that self-injure and those with eating disorders.

There’s nothing wrong with holding high principles, and wanting to perform one’s best is natural and healthy. However, when people start berating themselves for making a simple mistake, or make themselves sick with worry by trying to be perfect at all things, or by attempting to be all things to all people, that’s stepping into the unhealthy perfectionism arena. Unhealthy perfectionism can exact a high price on physical and emotional wellbeing, as well as taking a toll on self-esteem if high standards set for oneself are not met. Perfectionists often think in black and white terms, either something is right or wrong, flawless or a failure – there’s no middle ground or room for shades of grey.

Parents or primary caregivers often set the stage for the direction in which a child’s perfectionist tendencies take. For example, children raised in a critical and judgemental environment by parents who overtly or covertly convey the message to a child that he or she is not good enough, where praise and validation is lacking, or where siblings are openly compared with statements such as ‘Why can’t you be more like your sister?’, or ‘Why can’t you be brainy like your brother?’ can set up the beliefs that ‘he/she is better than me’, ‘she/he is more lovable than me’, or that ‘nothing I ever do is good enough’.

Believing that ‘only perfect is good enough’ can motivate a constant striving to get things 101% right, or to pushing oneself harder and harder, in the hope that it will bring appreciation, praise, love and acceptance.

In truth, there’s no such thing as perfection – it is in the eye of the beholder. To err is to be human and making mistakes makes people real. Sadly, however, to those with deeply ingrained unhealthy perfectionist traits, it rarely or never occurs to them that there is another way of thinking or behaving, and people often need professional help to set them on the path to freedom from detrimental perfectionism.

Changing negative core beliefs and building self-worth

We can secure other people’s approval, if we do right and try hard; but our own is worth a hundred of it.
—Mark Twain

The first step to change is becoming aware of negative core beliefs, the second is to challenge and dispute them and to replace them with more realistic beliefs, the final step is to start believing that one is a person of worth, without being dependent on outside approval. Many people find Cognitive Behavioural Therapy (CBT) helpful for recognising and changing flawed self-beliefs, and developing a healthier self-concept.

(See Chapter 12 for a brief description of CBT.)

No one can make you feel inferior without your consent.
—Eleanor Roosevelt

Case study 6.5: Tacita

In the final case study in this chapter, the consequences of never feeling good enough are clearly evident. Several other beliefs that stem from childhood are also apparent, namely – Don’t be disobedient – Don’t ask – Don’t speak – Don’t have an opinion – Don’t show emotions – Don’t cry – Be strong – Be perfect.

I am the oldest of three children and was raised with a strict Catholic upbringing. I was taught to never be disobedient, never ask for anything or have my own voice or say in any matter, and to be a brave soldier and never cry for anything, even if I was hurt. My father was my world – I lived for him, lived to please him, and always strove to do my best for him; it was expected. I was a straight-A student and played sports but the effort I put out was never good enough for my dad. There was always room for improvement, always that extra push to be an even better player and scholar.

When I was in eighth grade, my parents announced their pending divorce. None of us had a clue it was coming . . . my parents always seemed ok; they weren’t affectionate at all towards each other but they did ok. When the announcement was made to us, I could only sit there in shock. My siblings cried but I couldn’t. I felt as if I had lost everything, that I was the cause of everything. I felt that it was my fault, that I hadn’t been a good enough daughter, a good enough student, or a good enough anything for my parents.

By the end of that summer, things got out of control at home. My parents started fighting all the time in front of us. They would fight over money, dinners, and my siblings and me. Each time they fought, it drove the nail a little deeper into the coffin of emotion and self-hatred that I had buried in my heart. My dad became horrible to live with and I grew to despise him.

Being a ‘goody goody’ was no longer an option for me and I slowly began to sabotage that reputation. I started smoking cigarettes even though I abhorred the taste and smell of them. At some point in my freshman year I started ed [eating disorder] behaviour but not an ed [eating disorder]. This wasn’t for weight control; it was for control over myself, punishment for slowly and painfully becoming a ‘nothing’, being unable to fix anything. This also gave me a satisfaction that I could do something that no one else around me did.

I also started cutting around this time. The cutting started with my first attempt to kill myself. I remember how good it felt that first time . . . to just slowly cut deeper and deeper and feel the rush of emotion wash out with the blood. After that first time I was so calm, it was incredible. I was even able to go down to the dinner table and act like I hadn’t just cut into my arm. I somehow realised that this was a great way to let go of some steam since I never talked about what was going on inside of me and rarely showed negative emotion. I started cutting a lot and carried instruments on my person at all times. Good grades were a thing of the past and I no longer cared about studying or doing my best . . . there was no such thing as ‘my best’ anymore . . . there was no ‘me’.

Dad moved out near the end of my sophomore year and that was the biggest relief and sadness mixed into one big emotion. My bad behaviours continued into my senior year. I was lost in the darkness of self-destruction and hatred and was miserable.

I met my husband at work while I was still a senior in high school. We moved in together a few months after I graduated from high school and got married when I was 20. Things were good during this period . . . I worked two jobs and was happy with my life. Even though there was this somewhat happier period there was also something missing in my marriage . . . trust.

A few months after we got married, I wanted a child; some-one else to love and who would love me back. My first child was born the following summer and I enthusiastically delved into trying to be the best parent for my son along with trying to be the best at my full-time job. By spring, my aspirations of being a wonderful parent faltered and I began realising that I was failing to be a super mom, wife, and exemplary worker; my best was once again not good enough. Something was missing in me and I wasn’t quite sure what. I started my first real diet that spring after comments from my husband and others about my higher level of weight and finally began to excel in something . . . weight loss. This became my new obsession . . . losing weight and again doing something that no one else had the power to do. I was failing so miserably in all the other aspects of my life and this was something that I had control over.

I started seeing a therapist (unbeknownst to my husband) and instead of things getting better, they got worse. I couldn’t communicate and didn’t understand how to talk about what was going on inside. Many of my sessions revolved around the weather instead of dealing with things and I would often take breaks from therapy for months at a time due to frustration with myself and my therapist. Everything from the past had come rushing back and I couldn’t stop it. The SI came back with a vengeance on top of a now full-blown eating disorder. SI was a part of my nightly routine and became an addiction much worse than the teen years. I became suicidal and was lost in a haze of self-destruction which warranted a two week psych [psychiatric] hospital stay. Approximately three months after leaving the hospital, I was even worse with the ed behaviour, this time adding laxative abuse to restricting. My husband threatened to leave with my son if I didn’t enter another psych hospital, so I did time again on the psych ward, this time for a full month. I gained weight but again never talked to anyone about what was going on . . . I couldn’t.

It’s been nine years since my last hospitalisation. Currently, I’m not in therapy and am in recovery from the eating disorder though the thoughts and mindset are often still there. SI still plays a rather active role in my life and is a well-guarded secret. It’s what’s kept me alive and going through many changes in my life and I think it will keep me through many more.

Key points

• Not everyone who has suffered child abuse self-injures, nor has everyone who self-injures suffered child abuse. The reasons why people turn to self-injury are intricate and multi-faceted. There are numerous predisposing factors that motivate self-injury.
• Many people who self-injure hold deeply embedded negative core beliefs about themselves. Perfectionism is also a common trait, which may stem from the belief that nothing I ever do will be good enough. These beliefs can lead to low self-esteem, feelings of self-dislike, self-loathing, self-hate, and worthlessness, which in turn may ignite the need to self-injure.
• Child abuse provides fertile ground for the development of a range of adverse effects that can impede healthy adult functioning.
• Not being believed when abuse is disclosed by a child (particularly if the person confided in is a mother or other close relative) can have a profound psychological impact. Mothers choose not to believe for various reasons.
• Children don’t speak out about abuse for a number of reasons.
• Breaking the silence of abuse to someone who is willing to listen and believe is empowering.
• The notion that memories of child abuse can be forgotten, and then years later be remembered, sparked a bitter debate in the early 1990s, and instigated the formation of The False Memory Syndrome Foundation (FMSF), and The British False Memory Society (BFMS).
• Recovering memories of child abuse can be acutely distressing for clients and self-injury may escalate for a period while memories are being processed. Additional support may be needed at this difficult time, and pacing of sessions to enable clients to stay safe within the boundaries of the ‘bearable’ is critical.