It Hurts’

Trigger Warning!
Contains sensitive information, topics discussed such as suicide and self-harm. Read with caution. If anything causes you concern, you are welcome to email me or reach out to a mental health helpline. 

As we grow and develop, we identify our strengths, weaknesses and strive to make improvements. In doing so, we learn and develop coping strategies which help us cope with daily life and certain situations. These strategies can be learned in a variety of ways; taught, instinct, or copied from another individual. Most of our behaviours are adaptations of other peoples’ behaviour. As humans we survive by seeing what others do and adapt it to ourselves, to make it work in our reality. We learn, implement and adapt the behaviour to the circumstance/environment around us, a survival technique. This highlights our basic human instinct to survive and cope in an ever-changing world.

One coping strategy, which is self-destructive in nature and irrational is self-harming. The act of self-harm is to relieve pain, distract current thoughts and feelings. It is a learned behaviour, with the intent of either gaining attention of others and/ or cope with feelings. Self-harming behaviours can be misinterpreted as someone who is actively suicidal, this is not always the case. This behaviour is a cry for help, an indictor the individual is unable to cope and needs support. It’s not easy for someone to ask for help, so they find other ways to communicate this, and unfortunately, harming oneself can be one way. In addition, the inability to cope with, or regulate emotions, can trigger someone into thinking and acting upon self-harming.

As you can see there is not one reason why someone self-harms or a clear answer to the cause.

Self-harming is an external representation to an inner conflict or pain an individual is feeling. The behaviour is symbolic in nature. The abrasion of skin causes pain, which is a re-focus of current thoughts/feelings or to numb emotional pain. The release of blood is a representation of relief from the pain and releasing it from your body. Finally the instant reinforcement following the behaviour, leads to regular occurrence of the behaviour.

Here it’s important to recognise the individual is suffering. However, this psychological symbolism can become addictive and often leads to vicious cycle of self-harm.

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As with anything in life we become habituated to it, so we increase the intensity of the behaviour to continue to feel the same sensation and emotional release. So, understanding why an individual self-harms, contributes a major part in supporting an individual in crisis.

There is not an exhaustive list of types of self-harm but the common few are: – tying ligatures, headbanging, lacerations to forearms and upper thighs (other parts of the body also). Other types which may be less obvious are: – refusing medication, self-neglect, excessive or absent in eating, drinking fluid or attending to personal hygiene.

Self-harming is not a mental illness, it’s a behaviour related to emotional pain associated often with a mental illness. As stated previously, its an irrational coping mechanism, learned from others. It’s very difficult to change this behaviour pattern once learned and engaged in. As the therapeutic nature the individual gains from engaging in the behaviour, is often impossible to achieve from other coping strategies. But does not mean we condone self-harming behaviours.

Behaviour change is one of the most difficult challenges humans may face. Barriers to change include; not feeling the need to change, fear of consequences and being comfortable with current behaviours. The main reasons behaviour can be changed is because the individual is willing to change and recognises the need. If these components aren’t present you can’t expect someone to change their behaviour, upon request. A method which is used, in replace, is to hinder the individual from conducting in the behaviour. This may be to remove any items, which can be used inappropriately, monitoring the individual closely and intervening when they engage in the behaviour. However this is effective in the short term, its ineffective long term.

Therefore, understanding this, when supporting an individual whom is self-harming the goal is to help them recognise its an irritational coping mechanism, and how it can be changed.

Pause
Think about your coping mechanisms, would you willingly change them, and how easy would that be?
Answer- Probably wouldn’t want to change them, so remember this when you assume another person should change theirs. Understand the difficulty and work within the constraints of this.

Why fix something which isn’t broken?

The argument here is as much as the behaviour works for the individual, self-harming can cause an individual to feel more pain, guilt, emotional anger and torment and the individual can lose themselves to self-harming. When an individual is self-harming, they feel instant gratification and the behaviour is rein-enforced at this point.

Understanding the reasons for self-harm is one hurdle, understanding the cause/triggers can be difficult. Many situations, feelings and thoughts can trigger someone to engage in self destructive behaviours. Causes which may lead to self-harming are: – Bullying, PTSD, psychosis, visual/auditory hallucinations, unable to regulate emotions, trauma, depression and anxiety, stress and fear. This list is by no means exhaustive.

Self-harm is associated with females but is equally as prevalent in males. This lack of awareness may mean male individuals don’t ask for help, due to the fear of being judged. As self-harm is commonly associated with the inability to regulate emotions, and historically males are seen to be the stronger gender who aren’t as emotional as females. Interestingly, males whom self-harm may not be taken as seriously as a female whom is self-harming. Which may lead to a rapid decrease in mental state, and often suicide. As discussed in a previous blog about suicideBanned from speaking about Suicide!!!, male suicides are increasing.

Self-harm can lead to suicide in some cases. This is due to many factors, like the one discussed above. But also, because the gratification we first feel, goes away so the intensity increases to harm more frequently and more seriously to recreate the feeling. For example, if an individual begins with lacerating their forearm, they may cut deeper each time using sharper objects to achieve the relief, as they become numb over time. This can present as a rapid decline in mental state, as more serious attempts to self-harm, the individual may begin to have suicidal ideations. These can than manifest and attempts on their life will occur.

As much as self harming is used to escape pain or trauma. It’s also used in the intent to cause pain as a form of punishment. Often when an individual is feeling guilty, upset or angry towards a certain situation, overtime the feeling of resentment can occur, causing it to be directed upon oneself. For example if an individual has suffered abuse in their past they initially will be upset when they think about the memory. But overtime and with overthinking, they redirect the sadness and it turns into anger. This anger is associated with the abuser, but the individual will begin to think and convince themselves into being angry at oneself. This anger towards themselves, that for example it is their fault they got abused, causes inner pain that is difficult to cope with and confront. As the individual is unable to cope with this inner conflict, irrational behaviours are conducted to help solve the issue. One such behaviour is self harming. As described above it allows the individual to feel gratification but also a sign of punishment.

This scenario is very common, it’s often the driving force for many incidents. It’s not often obvious that the individual is self- punishing. But with support and understanding this can become clear. Here the way in which to support someone is to deal with the inner conflict first and make steps towards solving the problem. Until this has begun the punishment behaviour may not subside.

It’s the one thing I have control over!

Today’s society is fast paced, instantaneous and unfulfilling. People are judged and criticised more easily. Knowledge is at our fingerprints. But in amongst all of this we have little control of our lives. Most people are preoccupied with what next rather than what’s happening now.

For an individual with mental health issues, their ability to cope may be limited. Understanding and maintaining strategies can be impossible. So they seek areas in their lives they can control, only they have the power and no one can take this away. We see in individuals with eating disorders, it’s control of one aspect of their lives where they have the power to control. This is the same for individuals whom self harm, they are in control of this behaviour. They steer it and power it’s intensity.

When someone is self harming they are in control of the narrative; how deep to go, where they self harm, type of self harm etc. As much as self harming can be impulsive and an urge to be fulfilled. It also gives the individual power, power which they know another person can’t take from them. This can be used to their advantage, using self harm to their benefit and gain. In addition, it’s a form of emotional blackmail.

{It’s important to note that people who self harm aren’t being judged or critiqued for their behaviour}

Associations

As described at the beginning of the blog, there is a psychological symbolism linked to self harming. An irrational cycle is formed and difficult to break.

As human beings our behaviours are learned very much through positive and negative associations. We are more likely to engage in behaviours which have positive associations than negative. This may be obvious but we need to mindful that not all positively associated behaviours are actually “positive” behaviours. This notion stems from the infamous study conducted by Pavlov “Pavlov’s dog”. Here Pavlov created a positive association between hearing a bell, leading to a bodily reaction, with a positive outcome. This simple notion is the basis for all our behaviours. So using the same framework we can apply it to self harm; urge/impulse to self harm, engage in self harming behaviours, leading to instant gratification. The outcome here is positive as the urge/impulse has been fulfilled and you no longer have the desire. But for how long?

 

An attempt to break the cycle can cause further anguish and distress, so the individual reverts back to self harming to cope with the distress of change. However breaking the cycle isn’t impossible. Consistent and persistent. These are the two most important elements to any behaviour change. Anything we do in life we will succeed if we remain consistent in our actions and motivations and continue with it no matter. To be consistent you have good persistence. In order to be persistent you have to be consistent. Here I’m not trying to trick you with a philosophical idea , I’m showing the two go hand-in-hand.

Distraction Techniques

  • Keeping a diary
  • Listening to music
  • Safe self harming
  • Art/crafts
  • Doing some exercise
  • Going for a walk
  • Talking to someone
  • Breathing techniques/ Mindfulness
  • Grounding techniques
  • Delaying self harm

All the above and many more can be used as effective techniques to refocus your thoughts and train your mind to think differently.

Delaying self harm

Here you wait five minutes before you self-harm. This can be very challenging but very rewarding. Overtime you gradually increase the time gaps between each time you self harm. This is used to help resist the urge or sudden impulse to self harm. Re-training your mind and the associations made to self harm.

Grounding Techniques

  • Name 5 things you can hear
  • Name 4 things you can see
  • Name 3 things you can smell
  • Name 2 things you can feel
  • Name 1 thing you can taste

This technique, though vey simple is very effective. It works by re-focusing the individual back into the enviorment they are in. Breking the cycle of thoughts they may be lost within.

Breathing Techniques

  • Take a deep breath in, hold for 3 secs and take a deep breath out ( repeat as many times as needed
  • Tense all the muscles in your body, than slowly focus attention on one muscle and relax it. Work you way throuh the entire body relaxing each part. During this take slow controlled breaths.

 

Mental health helplines

Whether you’re concerned about yourself or a loved one, these helplines and support groups can offer expert advice.

Anxiety UK

Charity providing support if you’ve been diagnosed with an anxiety condition.

Phone: 03444 775 774 (Mon to Fri, 9.30am to 5.30pm)

Website: www.anxietyuk.org.uk

Bipolar UK

A charity helping people living with manic depression or bipolar disorder.

Website: www.bipolaruk.org.uk

CALM

CALM is the Campaign Against Living Miserably, for men aged 15 to 35.

Phone: 0800 58 58 58 (daily, 5pm to midnight)

Website: www.thecalmzone.net

Men’s Health Forum

24/7 stress support for men by text, chat and email.

Website: www.menshealthforum.org.uk

Mental Health Foundation

Provides information and support for anyone with mental health problems or learning disabilities.

Website: www.mentalhealth.org.uk

Mind

Promotes the views and needs of people with mental health problems.

Phone: 0300 123 3393 (Mon to Fri, 9am to 6pm)

Website: www.mind.org.uk

No Panic

Voluntary charity offering support for sufferers of panic attacks and obsessive compulsive disorder (OCD). Offers a course to help overcome your phobia/OCD. Includes a helpline.

Phone: 0844 967 4848 (daily, 10am to 10pm)

Website: www.nopanic.org.uk

PAPYRUS

Young suicide prevention society.

Phone: HOPElineUK 0800 068 4141 (Mon to Fri,10am to 5pm & 7 to 10pm. Weekends 2 to 5pm)

Website: www.papyrus-uk.org

Rethink Mental Illness

Support and advice for people living with mental illness.

Phone: 0300 5000 927 (Mon to Fri, 9.30am to 4pm)

Website: www.rethink.org

Samaritans

Confidential support for people experiencing feelings of distress or despair.

Phone: 116 123 (free 24-hour helpline)

Website: www.samaritans.org.uk

SANE

Emotional support, information and guidance for people affected by mental illness, their families and carers.

SANEline: 0300 304 7000 (daily, 4.30 to 10.30pm)

Textcare: comfort and care via text message, sent when the person needs it most: http://www.sane.org.uk/textcare

Peer support forum: www.sane.org.uk/supportforum

Website: www.sane.org.uk/support

YoungMinds

Information on child and adolescent mental health. Services for parents and professionals.

Phone: Parents’ helpline 0808 802 5544 (Mon to Fri, 9.30am to 4pm)

Website: www.youngminds.org.uk

Abuse (child, sexual, domestic violence)

NSPCC

Children’s charity dedicated to ending child abuse and child cruelty.

Phone: 0800 1111 for Childline for children (24-hour helpline)

0808 800 5000 for adults concerned about a child (24-hour helpline)

Website: www.nspcc.org.uk

Refuge

Advice on dealing with domestic violence.

Phone: 0808 2000 247 (24-hour helpline)

Website: www.refuge.org.uk

Crime victims

Rape Crisis

To find your local services phone: 0808 802 9999 (daily, 12 to 2.30pm, 7 to 9.30pm)

Website: www.rapecrisis.org.uk

Victim Support

Phone: 0808 168 9111 (24-hour helpline)

Website: www.victimsupport.org

Eating disorders

Beat

Phone: 0808 801 0677 (adults) or 0808 801 0711 (for under-18s)

Website: www.b-eat.co.uk

 

No one is perfect

Many people throw the words perfect, normal , abnormal around easily. The functionality and meaning behind the words is being lost. They are being used and meant in contexts which offer a different suggestion to the meaning than initially intended.

Let’s firstly take the word perfect. What is perfection? Here is the definition :-

But do we use it as it was intended? Is there such thing as perfection? When we use the word “perfect”, we are indirectly comparing it with something we see as imperfect, to make that perfect. The danger is we use the word perfect to describe people’s looks, personality etc. But than whom are we to indirectly compare people? Who is deemed imperfect for them to be seen as perfect?

For me the element of perfection, is subjective and the word should be used with caution. As in doing so, you may be offending someone.

Now let’s look at normal vs abnormal .

So normal is used when we look at the whole and see where you fit. Dependent on where you lie, you are seen as normal or abnormal. This phenomenon is used in psychological research known as Normal Distribution. But is often a reflection of daily life.

Above is the normal distribution curve used by researchers to understand data. On the curve if you fall on the main centre line you are deemed “perfect” or “normal”. If you fall anywhere within the curvature you are seen as normal. But the further away from the centre line you fall the more abnormal you appear. If you fall completely above the curved line, you are known as an anomaly and which is often removed, as it can skew the data. This than cause the data to be unusable and insignificant, researchers always aim for significant results.

This method to understanding data, can be applied to our daily lives and the general population. For example we all hold our own standards and expectations, based on our experiences and beliefs. If someone/something falls out of range from our expectations, we immediately view them as an anomaly and abnormal.

Unfortunately this crude thinking has been placed on certain groups of people. One such group is, the mentally ill. For centuries, being mentally ill, led the individual into being outcast from society and isolated, alone and forgotten. Also ridiculed and shamed in public. Many were killed or imprisoned . Society is unable to cope with anyone whom lies outside the norm or who strays to far away from it. Like in research the abnormality is dealt with, often removed. But does society have a right to do this??

However from centuries of viewing individuals with mental health as “abnormal”, humanity has created an ingrained judgmental and discriminatory culture and feeling towards the mentally ill. Still to this day, individuals with a mental illness are isolated from their family or community.

Upon reflection and observation, how does this help the individual and how are we making them feel?

In today’s society the rate of suicide is becoming more prevalent. There are many factors which are involved with suicide, one being- how they are treated and viewed by the general public. As humans, we are fearful and defensive to the unknown, we observe and assess the risk. This is a natural human response. However what we find is people whom don’t understand mental health will stare, comment and make the individual feel uncomfortable. We may not even realise we are doing it!

We fail to realise the impact such terminology can have on a person.

If someone is constantly referred to as abnormal, they begin to see themselves as abnormal and intern will develop a low self esteem. They will regard themselves as lesser than thou. Meaning, they have a defeated outlook to life, little to no confidence, subsequently may develop depression.

Words are very powerful and can have a major impact on others lives. We all must be mindful in what we say, what descriptive words we choose to use and how we express our thoughts. Being mindful of this ensures that no one feel inferior than another or outcast.

I’m

I hide behind a wall I’ve built, it protects me from the outside world, I can keep secrets in. I can remain protected and defensive , the inner battles I face, I fight alone. Occasionally I let people in, only the surface layer, see how they react. I’m careful how I behave, show emotion and present in-front of everyone. I wear a fake smile, pretend to laugh and appear stress free. I’ve become good at acting, acting how others want me to be. So I don’t make them feel uncomfortable around me. I’m protected from judgment, people talking about me and those sympathetic looks. If only somebody will look closely at my eyes. They will see pain, anguish, a person struggling, unable to cope, a person alone and upset. I want to reach out, I want to share but I’m paralysed by my own battles.

Look beyond the obvious, as nothing is always what it seems.

No words

A hug says more than words ever can. It lets the other person know you care, you are there for them and they aren’t alone. Being embraced by another when you feel down, is a gentle reminder that there is always someone with you.

For many whom may not have grown up with a good system and strong relationships, may find a hug the embrace they needed.

When someone you know looks upset, see if they are ok and give them a hug, you may be the only person that day who has.

Let’s help

Always be the helping hand for others even if no one holds their hand for you. We help others who intern will go into help more people. We start the cycle but we can also end the cycle. If we think “no one is helping me so why should I help them”, we begin down a dark lonely path. We become bitter towards others and spiteful in our actions. Let’s choose empathy and kindness. Be thankful that we aren’t in similar situations but have the strength and capability to guide others through theirs. Helping others is a selfless act and the helper shouldn’t expect praise, recognition or require validation for the help they have given. Once an individual seeks praise or recognition, the act of helping becomes a selfish act to feed your own ego.

I like many others around the world help others before I help myself. I make time even if I have none for someone who needs my time. I talk to someone who needs distraction. I listen to someone who needs to vent. I be there for someone even if I’m physically exhausted or emotionally drained. I find the inner strength so others feel supported. Let’s all make this our motto and spread the word.

#supportyourfriends #supporteachother❤️ #offerahelpinghand #beselfless

Part 2 of the physical vs. mental health debate

The invisible illness

For as long as humans have existed, they have lived by the notion ‘if I can’t see it, then it’s not real’. This has been applied to the unknown varying from; aliens, ghosts, spiritual beings etc. It has also been used to refer to mental illness, as often you aren’t able to identify any visible symptoms, abnormalities in brain function or chemical imbalances. People assume that the illness does not exist. In comparison, any physical illness can be explained by evidence found in objective testing such as; blood test, EEG/ECG, MRI, CAT scan, blood pressure monitor, blood sugar monitor etc. These are all signs that can be equated and explain a physical illness. But something which is not visible to many means that it does not exist and is made up. 

Most of societies believe mental illness is ‘made up’, the person is ‘exaggerating or a drama queen’, and it’s ‘all in their head’. But this is a misconception and misjudgement of an illness. What we can’t see doesn’t mean it doesn’t exist. Just because you don’t understand something, doesn’t mean you write it off. Most mental illnesses are subjective in nature, only the individual is bale to express the symptoms of the illness, these can vary from; hearing voices, hallucinations or emotion (sadness, anger, mania etc.). These symptoms may not be easily identifiable to others and have to be expressed by the individual.

So the question is how do we know these symptoms are real?

There are many tell-tale signs which can prove these subjective symptoms are symptoms of a mental illness.

For example, hearing voices, this is something which can’t be proven or disproven. The individual will often appear distracted, appears to be listening to unseen stimuli and responding verbally and non-verbally to the unseen stimuli. In addition, they may become manic, angry or distressed spontaneously, often the result of the voices. Their actions may be impulsive and sporadic in nature. They may not make eye contact, illogical thought processes and pressured speech. This is not an exhaustive list, but a brief over view of some common signs.

If properly observed and assessed, than this shows the individual hears voices. However, the assessment is individualistic to the person conducting the assessment, but does not make it any less valid.

Unlike physical illnesses which use scientific tools that measure in real time the illness and computes evidence that cannot be refuted. Mental illnesses are based upon psychometric testing, diagnostic guides and subjective assessments of the individual. So both physical and mental illness use differing diagnostic methods, but both are scientifically proven by research and valid in nature.

Many individuals, whom believe in the bio-medical model to health, don’t view the study and assessment of mental illness scientific. Therefore, they are more likely to dismiss symptoms or miss- interprets them, based on their perception. This can lead to patients being untreated or mis-diagnosed. This practice is becoming uncommon, in today’s society but can occur.

Individuals studying medicine, GPs and other healthcare professionals, are now being trained in mental illness and psychology, so they are able to spot signs early and assess more effectively. This shows a positive step forward, as the medical model is being challenged and used in conjunction with psychological models for assessment.

Let’s not be mistaken, physical illness can lead to mental illness, and vice versa. This is very common and so the two are being treated together. I have experience in working in health psychology, which combines both physical and mental health. I used to work in oncology and engage in patients whom were at varying stages of their oncology journey, and suffered from some psychological distress due to the illness and/or treatment. Their mental states often would steer their oncology treatment and vice versa. Patients may become depressed and have fleeting thoughts to self-harm, so would stop their current treatment or delay it. Others may have increased anxiety surrounding treatment and would look to homeopathy medications such as cannabis oil, to avoid having more treatment. Working in health psychology gave me great insight into how psychology and the medical community were integrating in their approach to care.

The perception of illness varies greatly from person to person. One individual may be very empathic and caring, whereas another may engage in tough love. This variation is based on our perceptions and experiences in life. Very little can completely change our perception, as we always find a natural way to revert back to it. In terms of physical health our perception is very accepting, a sense of urgency, in terms of receiving treatment and ensuring the care needed is received. This also translates to mental health, but there is a difference.

For example, if there is an individual lying on the floor, screaming and shouting they are in pain and unable to move, holding their leg. Without any judgment, question or delay we ensure they are ok and call the paramedics as we can see they are hurt. This is a very common and natural response.

Now lets take the same scenario as above, with the individual on the floor, in apparent pain and unable to move, but you have knowledge they suffer with a mental illness. Does your response change? Interestingly, many will have the same response as depicted above. But there are a group of people, whom will delay calling the paramedics, they will assess, question, judge and doubt the validity of the pain. Questions will be raised and their mental health history will be looked into, so see if they have exhibited this behaviour before. Then a judgment will be made whether to send them to A&E or not. But is this delay in care reasonable?

Sit back and compare both situations. They are the same situation with only one difference between them But as you can see, one added piece of information can change your perception.

This is not an uncommon occurrence. Having the knowledge that an individual has a mental illness, throws doubt into a person’s mind. To the extent their care and treatment is under question. So why do we this?

On one side, the questioning and doubt can be justified as you want to ensure they aren’t wasting NHS resources or don’t want to re-enforce the behaviour. On the other hand though, its not so logical. The reasoning for questioning may be based on a biased perception, lack of knowledge, or opinion. This can cloud judgement and can lead to prejudice behaviour.

Physical health is an area we all feel we know enough about to make judgement calls and feel they justified, by our knowledge base. But can this be the case in the above scenario. If someone is in pain and state they are unable to move, should they be taken to A&E straight away?  Is this really the case? If you answered Yes than what is your justification based on the information given.  As much as there is judgment and bias towards mental health care, this also is present in physical health care.

One important message to understand is we can never be completely objective, but we have to mindful of our perceptions, bias and judgments. As discussed, physical and mental health are deemed separate and in some respects they are different. But as times change, our knowledge grows and we understand the two are one of the same and can be treated equally.