Written by Jonathan Clark
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Ask anyone who works with people, including pastors and church leaders, as to which events they find most challenging and daunting in their work, and two issues are sure to turn up in almost every list.
The first is dealing with a person who is suicidal, and the second is what to do when someone is self-harming. Often self-harm is seen as the most challenging, as it goes against our inbuilt expectations and revulsions, and is often less easy to understand and make sense of.
Many see suicide and self-harm as two aspects of the same issue, especially as they are frequently mentioned in the same breath. But they are two distinct issues, although there can be some overlap.
Suicidal behaviour is first and foremost focused on the ending of life, whereas self-harm is focused on coping with life. The one common suicidal method that appears similar to self-harm is wrist cutting. But this is usually very different to self-harm cutting in location, as wrist cutting is usually across the wrist itself and is aimed at cutting deep enough to cause excessive bleeding, whilst self-harm cutting is usually higher up on the fore arm. The easy way to tell the difference is to ask the person for clarification as to their intent when they did it. Was it to cut their wrist planning to die, or to self-harm? Sometimes a person may try cutting their wrist initially as a suicide attempt and find a sense of relief through the act of cutting, and then go on to self-harming.
If a person is regularly self-harming, they will be unlikely to be looking for death as an outcome, but instead trying to find a way to get through the day.
In this, self-harm has much in common with alcohol or drug use, and other addictive or dependency-creating behaviours - in fact, any behaviour which a person uses to help them cope with the pressures and difficulties of life. Self-harm is a coping mechanism. It may, to the person on the outside, appear extreme, violent, abusive and gory, but it is still a coping mechanism. As such, if a person is relying on self-harm to cope with life day by day, there's a need to be aware that an enforced stopping of it will remove the key method the person has found to cope with life.
So how does self-harm help a person cope?
To understand this you need to consider what is happening in the person's life. The individual who is self-harming will be trying to cope with something(s) deeply distressing, deep inside their being. There may be a range of things, from recent experiences, or the effect of one or more experiences in the past, to an accumulation of issues from their life so far which have left a legacy of hurt, pain, guilt, distress, anger, fear, and bitterness.
With this type of thing happening inside, the question is, what do you do with it? Do you seek help? Many have learned that this can just make them more vulnerable. Often we seek to meet the need ourselves and to find some way of nullifying the feelings inside; a way to tranquillize the feelings, put them to sleep, escape for a while or be distracted from them. Some will drink alcohol in enough quantity to reach oblivion. Others use prescribed or illicit drugs. Some will use sex, relationships, gambling, risk taking, and reckless behaviours. Self-harm falls within the category of these other coping mechanisms as it acts in a very similar and specific way.
So how does it work?
Yes, self-harm does `work` as a coping mechanism. It is never to be recommended, just as we would never recommend other inappropriate coping mechanisms, but for many individuals it is briefly very effective, albeit damaging and potentially dangerous.
Self-harm usually involves inflicting an injury on the person's own body. It may involve cutting, burning, hair pulling, intense rubbing, scratching, swallowing, punching, and head banging. The person may start self-harming by learning from others who already self-harm, but many will find out by accident. They will do something out of frustration, anger, distress or in cutting their wrists as above, and find that by causing an injury or pain they feel a sense of relief, release, and an escape from their inner hurt and pain.
Most of these methods of self-harm have a very specific effect on the person. The effect is based on a natural physical bodily response to attack, injury and pain. Our bodies are designed to respond immediately when they are injured in any way, whether by a cut, blow, or other form of trauma. The body responds by going into emergency mode, calling internally for its own 'emergency services' to come and deal with the injury. This works through chemicals being produced such as endorphins and adrenaline. These are naturally-produced chemicals which are designed to assist with the person's ability to cope with the injury. The effect for the individual is to receive pain relief, as the chemicals released are a natural tranquillizer; to be given a high, comparable to taking an illicit drug, as endorphin is akin to morphine; to be given energy and feel more alive as the body equips the person to react to the “attack", enabling the fight-or-flight reflex.
The power of this effect is very strong. It is often compared to taking drugs, or sexual orgasm. For a short period the person can find a way to cover their hurt and pain inside. It is not just the physical pain covering the emotional pain, although this can be part of it, but it involves the whole effect of the short-term influence of the chemicals on how the person feels.
Self-harm gives a short-lived effect; powerful, but short lived. This leaves the person in the same state as before, but now they can be even more aware of the pain they are in. This is why there is a pressure to do it again and again, to find a way to cope with the pain. It solves nothing, but gives temporary relief. In this way it is addictive, and the person becomes dependent on the use of the chemicals they trigger through self-harming. It can also be used in combination with other such activities – alcohol, drugs, etc.
Once a person has begun to self-harm there are therefore two issues to be considered. The first is why they started, and the second is the potential dependency on self-harming. Both need to be dealt with. Stopping self-harming alone does nothing to deal with the cause, and leaves them desperate for a way to cope. But also, just focusing on the initial problems does not remove the coping habit they have formed.
What they need, therefore, is for someone (or some people) to come alongside them, and enable them to feel supported and cared for because someone is `there for them`. They need to have the opportunity to express how they are feeling deep down inside; to talk about whatever is on their mind; and to begin to allow the built-up pressure and emotion to be released. They will need to feel able to trust those who are giving them support, and this may take time.
It is essential for the supporter(s) to be clear regarding what they are offering and when, and to create realistic boundaries and be consistent. This will give the person a sense of security and stability. Do not have unrealistic expectations of them. Show them care and respect. Remember that their lives may have been chaotic for some while, and it takes time for them to feel secure, and to learn to trust.
As they find other ways to express their inner feelings and begin to find healing from the deep hurt and pain, they will feel less pressure to self-harm. Encourage them to develop interests and activities which may equip them to find fulfilment and a creative outlet. Help them find hope and a sense of self-worth, encouraging restoration in their human spirit.
Then as regards the self-harming activity itself, it can be unreasonable to insist on their just stopping. However, there are some techniques which may help the person change their behaviour. These are based on creating an alternative activity or response to replace the action and response from self-harming. They may work for some and not for others; often a person finds one is particularly effective for their individual needs. These can include:
- Intense exercise, either on a regular basis or specifically when they feel the emotional pressure building. For example: cycling; running; working out; even walking. This activates the body and triggers chemicals inside in a positive way.
- Eating something that gives an intense sensation. We all know what it is like to eat a lemon or grapefruit, or a hot curry, or a strong mint. This sensation can be helpful as again it triggers chemicals similar to those triggered by self harm.
- Going through the motions of self harming, but using something other than a sharp implement, and therefore avoiding actual cutting. For example: taking an elastic band and pinging it against their skin; using a blunt knife or implement to give the feeling of cutting without cutting; using the point of a pen to run across the skin without doing harm. This can be effective if it is used to draw a line, particularly if it is a red pen.
- Any other activity which gives the body an intense sensation without it being damaging or harmful. These can include putting ice on the skin; having a cold shower; expressing emotions through words, singing, music, dance, painting.
These methods (plus any others that the individual can find for themselves) are not a final solution or cure; but they are a step in the process of moving on from self-harming.
Surely it is a cry for help?
The person might be crying inside, in fact probably screaming out from within, but self-harm itself is not usually a cry for help but a means of self-help. Self-harming individuals will often try to hide the injuries from others. These are usually on the arms and legs; places that can be covered. Self-harm is often a private activity that only becomes noticed by accident, or if cuts or scars are exposed in the summer. As time goes on, however, the person might start cutting other places when they need greater effect or are more desperate. This gives yet another factor for consideration of their need for support: the self-harm is not enough to help them cope; their distress is such that the expression of their distress is increasing. This is often when additional coping mechanisms are added.
For some self-harm may be linked to self-punishment, based on a sense of guilt, or have other symbolic or ritualistic meaning such as sacrifice or release of blood. For others it gives a sense of being alive: being able to feel means that they are real, or it gives a sense of being in control of their life, their body, their pain.
So what can I do?
The first and foremost thing is to be there for the person. If they have shared with you it means they are putting their trust in you and being vulnerable with you.
For further information regarding a Christian response to mental health issues, please visit the Premier Mind and Soul website, www.mindandsoul.info. Other useful resources are www.selfharm.co.uk ; www.adullam-ministries.org.uk.
Jonathan Clark is Director for Premier Life at Premier Christian Radio - www.premier.org.uk - which includes Premier Mind and Soul and Premier Lifeline. Jonathan has worked in mental health since 1983 and has a special interest in working with people who attempt suicide or self-harm. He has been a Pastor and is involved in the healing ministry through teaching and prayer ministry.
© Jonathan Clark 2012.