Saturday, February 04, 2006

Safe self-harm?

Should self-harmers be given clean blades, to minimize infection? Times Online:
"The motion to be debated at the RCN (Royal College of Nursing) Congress has been put forward by the mental health nursing forum, an RCN division. It states: “Safe self-harm — is it possible? That this meeting of the RCN Congress discusses the nurse’s role in enabling safe self-harm.”

According to proposers of the motion, some nurses already stay with patients while they harm themselves to ensure they do so as safely as possible. One, who declined to be named ahead of the debate, said: “There are some areas of Britain where they have already explored safe self-harm. We may not like someone self-harming, but they are going to do it whether we like it or not and we will need to deal with the problems afterwards.”


Blogger Donna said...

Actually, many self-harmers that I know are very careful about infection. They don't want that to happen, so they are careful before and after.

8:44 PM  
Blogger Fallen Angels said...

From the article...
"My instinct is that it is better to sit with the patient and talk to them while they are self-harming. We should definitely give advice on safer parts of the body to cut. It could get to the stage where we could have a discussion with the patient about how deep the cuts were going to be and how many.” I am thinking this may be a very good idea, but I say take it further. Get to the stage where there is a discussion about what you (the patient) are feeling right now, while cutting. Not later, when the feelings leading up to and during the cutting have given way to the guilt about cutting itself. I'm struggling with this myself now...and I can't remember anything during the actual cutting. Having someone (a professional) talk to me at that time might be a huge help in breaking the cycle completely.


10:01 PM  
Anonymous flaweplan said...

If this is an attempt by the nursing profession to meet the behavior on its own terms then I think that's a good thing. I haven't read the article yet, but it sounds like a way to both honor the symbolism of the act while advancing a non-invasive alternative.
A standard practice of Dialetical Behaviorist groups recommends transitioning from razors to using ice cubes and snapping heavy rubber bands, others keep red ink and paint around the house to apply instead of cutting. But this is tribal, in-group support, what I find interesting is that nurses are even talking about meeting this population on collaborative and non-adversarial grounds....

3:28 AM  
Anonymous flawedplan said...

That's what I get for commenting on articles before reading them--ok, so they're proposing sterile razors, clean environments and engagement with patients while cutting, and this naturally has the moralists up in arms. I think it takes courage, sitting with disturbing reality you don't like or want to deal with, and it just might create a collaborative and therapeutic alliance. I'm for anything that subverts the current paradigm of punishment:

"An inquiry by the National Institute for Health and Clinical Excellence (Nice) revealed doctors sometimes stitched the wounds without anaesthetic because the patients had brought the injury upon themselves."

Well yes, there is that.

Perhaps this attitude bears as much investigation as the bizarros intent on harming themselves.

6:38 AM  
Blogger Fallen Angels said...

Well, I agreed with everything FlawedPlan said until the last sentence. And what I take away from the comments now is stigma. I am "bizzaro". Sad, but that is what sticks with me after all the other comments. If that is what I, someone who knows about and to as much a degree as I can, understand SI...what are those that don't know and understand going to take away? The reality is I am no more bizzaro than the next person. Yes I have my issues...pretty major issues, but no one will know that when they meet me. No one (one professor excluded) knows that at school. In fact, I am often one that is looked to for help, advice and support by other people...because they don't know, they think I have it "all together" (this actually gets me into trouble sometimes...triggers).
For a great expanation of SI go to Dr Deb's blog...


10:46 AM  
Blogger Joel said...

The one thing about my "bizarre" habits (compulsive skin picking or CSP) is that I hurt only myself. I think society and psychiatry better address it to habits like alcoholism which I see as creating a mentally unstable state for the sake of the state.

That's not all that different from my skin picking, whose purpose, I believe, is to give me a heightened sense of touch.

[Sera: I know we have had fights lately, but I'm with you on the stigma. You don't have to carry that weight. Never let a single stupid comment -- or a host of them -- undermine your self-esteem. I see you as profoundly human. Just like me. Just like shrinkette. Just like every pair of human corneas and retinas that we meet.]

This article made me investigate what made my CSP so pleasureable, so I wrote a piece:

6:26 PM  
Blogger Jil said...

I am also a bizzaro, since age 15...about 12 years. I am extremely careful about infection. Good Lord, I cant imagine sitting with someone while I do it though, that would be completely freaky. To be honest though, if I had someone with me, I wouldnt do it in the first place most of the time. I have only escaped company to cut or burn a couple of times. I think its awesome that you guys are even talking about the issue though....well, other than the "bizzaro" comment.

9:43 PM  
Anonymous Anonymous said...

i feel very strongly flawedplan owes an apology for continuing the stigma. thats a terrific way to help - maybe even better than making us SI in front of some stranger.

9:55 PM  
Anonymous flawedplan said...

Bizarro checking in! Sorry my gallows humor was misunderstood, but it's simply turning stigma on its head, a common defense among stigmatized groups ("queer" being one notable example). Sorry if the reference was misunderstood, I am a lifelong member of the population under scrutiny, and run a website myself devoted to mental health reform.

11:49 PM  
Anonymous Anonymous said...

Thank you to Shrinkette for posting that article. I can tell you that I was scrupulous about infection, because I didn't want to have to see a doctor.

I have never been as humiliated as I have been when it was necessary to go to the ER to get treatment. I, too, have gotten stitches without anesthesia. Except for one exception, I was treated by doctors with extreme contempt (for example, not speaking or looking at me, as if I were less than human).

I would be extremely interested in responses from physicians concerning how they feel about treating self-injurers. Is this changing as more is written about self-injury, or do they even care what it means or why people do it? For example, learning that there are those of us who do not it for attention (I never told anyone, nor would I have chosen such extreme humiliation as a way to to get it)?

8:18 AM  
Anonymous Anonymous said...

I was always very careful, using rubbing alcohol on the instrument and cleaning carefully afterwards. I definitely did not want to face a doctor. One time I had to get stitches and the doctor could hardly stand to deal with me. They were also rude when they took out the stitches. Of course, it didn't help that I had a psychiatric history and they could see that by the width of my chart.

Why do I do it? To feel real, I think. I have no emotion when I decide to do it and none during. Afterward, I feel MUCH better and clean things up and hide the results. The endorphins that someone mentioned really do happen.

Anonymous because of the shame involved.

10:29 AM  
Blogger Gimpy Mumpy said...

It would seem that what is truly needed is more rigorous awareness training for ER and other medical staff.

10:43 AM  
Blogger Joel said...

Could self-cutting/skin picking/trichillomania also be a cry for help? How many of the self-cutters/pickers/pullers attempted suicide?

4:01 PM  
Blogger Jil said...

I wrote about my self harm issues on my blog today

5:26 PM  
Blogger Jil said...

oh yeah, Joel, Ive attempted, as you know...but never by cutting, ive never really thought of it as a suicidal thing, thats interesting

5:27 PM  
Anonymous Anonymous said...

Joel, I did once, but never by cutting. In fact, my cutting was a way of getting rid of, or at least lessening, the feelings that were making me suicidal. It was a way of "de-escalating" before things got that far. It was never a cry for help for me, as I didn't tell anyone I did it.

8:23 PM  
Anonymous Anonymous said...

I've used someone else's dirty razor to cut myself with when in a psychiatric hospital. I was going to hurt myself somehow, so a clean razor would have been much better. I don't see it as any different from the provision of needle exchanges and condoms, particularly in prisons.

2:10 AM  
Blogger Barb said...

I got here through Jil's blog. "Safe self-injury" sounds like an oxymoron to me. My problem with cutting is that it's become a trend among some teenagers. They glorify it. That's utterly ridiculous.

When I used to cut, part of the "soothing" nature was doing it alone, by myself. To me, having someone there while cutting seems like a violation of privacy. Am I wrong that most cutters prefer to do it alone?

I agree that doctors treating self-injurers should be more compassionate, certainly not judgmental, but again--how much of their attitude is fueled by this cutting "trend"?

6:58 PM  
Blogger Kim said...

I am not understanding the lack of compassion and punishment (not using anesthetic) by ER staff. Our doctors may have their own ideas about self-injury, but I've never seen one treat a patient requiring emergency treatment as though they were a criminal.

People who are dealing with psychological issues are just that people dealing with issues. Not a psychiatric diagnosis running around in a body.

It's the 21st century. You would think we'd have come farther than this by now.

12:47 AM  
Blogger Fallen Angels said...

Barb, you aren't wrog about the alone aspect. It's also true that most "cutters" and others who use different types of self harm hide it...this is why I often get upset when people refer to it as "attention seeking behavior" can it be attention seeking if no attention is sought? I definitely prefer (and always) do it when alone...if my partner is home, that is a huge deterent. This is why I think that *for me personally*, having someone (again, a professional I trust, such as my T or pdoc)there talking to me would really help in breaking the cycle.


7:50 AM  
Blogger Donna said...

Kim, doctors get pissed off at cutters because they are wasting the doctor's valuable time, when the could be saving someone's life or something. I don't know. All I know is that the mentally ill are not well thought of by doctors and nurses and are seen as a pain in the ass. I've seen it in person when I did an internship at a busy Level I trauma center.

9:46 AM  
Blogger Barb said...

Sera, I see what you mean about having a professional there to help you stop. I have to admit, however, that for me, half the time it was attention-seeking behavior. The other half, it was to relieve emotional pain/anxiety through physical pain, which is easier to heal. Good luck. :)

4:08 PM  
Anonymous Anonymous said...


I wish that the medical field had come farther by now too. I will have to say that each time, the nurses were extremely compassionate and caring. I don't know if that's because they know more about self-injury, or they are just compassionate to begin with. I only wish that somehow the doctors could get it into their heads that those who self-injure are humans too, who don't deserve to be treated in an inhumane manner.

10:02 PM  
Anonymous melissa said...

It brings me much insight to read this discussion. I found this page doing a search on safe self-harm. I am currently a grad student for counseling. Growing up my younger sister consistantly engaged in SIB , mostly cutting. At times I would walk in on her cutting and we would have a discussion mostly with me pleaing with her to stop. Obviously it didnt work and at the time I didnt understand what was going on with her.
Through my studies in school and random searches I have learned alot.
With the new proposal I am mixed on the feeling. It reminds me of 'tough love' for persons whom are suicidal. You know when a family member says well if your going to do it.... and then gives them a gun. I am not willing to take that kind of risk and with safe self-harm I am nervous if clean objects are provided cutting will not only increase in quantity but also severity.
On the other hand, from a counselors perspective I like the idea of someone being there and talking them through it but not just to be there and learn but as part of a plan to terminate the behavior. The belief that this might work was confirmed for me while reading your entries. Most persons involved in SIB like to do it alone. I do not believe it is attention seeking, I would lean more towards a 'cry for help'. I believe SIB signifies the need to cope with something and not knowing how else to do this. I think having a professional around would be beneficial to those who cut etc. because then they would have soemone to help them find other ways to 'deal or cope' with what ever it is that is causing them to feel the need to SI.

8:35 AM  

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