You’re gonna carry that weight a long time…

I had my bloods done this week. I have blood taken most weeks. This time I had a new nurse. She asked about my scars (nicely). I replied self harm. She exhaled sympathetically and said ‘it certainly left its mark’. Ain’t that the truth.

There’s the obvious scars all over my skin. The toll on my body that you can read about in my medical records and the indelible marks on my mind. Then the more I thought about it the clearer I saw that self harm has permeated throughout my life. I have so many habits, rules & thoughts that all loop back to a time when I was routinely hurting myself. The depth of it is both a revelation and strikingly obvious. Which is confusing, so I’m just going to unpack it here. Someone once told me they read my writing because it’s the best way to work out what I’m actually thinking. That’s often why I write it. So, excuse me if I explore my insides with an audience.

There are seemingly trivial things that at first glance appear to be just casual preferences. I only buy dark bedsheets. All my bedding is black or red or purple. Sure, I like those colours, but really I switched to exclusively dark tones because you can’t get blood stains out of the lighter ones. You also can’t see the stains between washing. I realise how gross that sounds, but when you always have open wounds, your sheets are continuously bloody. You get used to it. Ditto all of the above for dark coloured jammies. Along similar lines is my constant manicure. I’ve always liked to paint my nails. However, I didn’t need to keep my nails painted at all times until cutting came along. If you didn’t know, it can be really hard to get blood out from under finger nails. You can scrub for hours and still see red. Covering the tell tale crimson tinge became routine. My love of shiny black polish on my toes has the same origins. My toes don’t see a lot of blood these days, but necessity has grown into habit. My cardigan collection also has secrets origins. I have a million cardigans, shrugs etc. Whenever I buy any outfit I immediately run through what cover up I could match with it. I don’t even keep my scars covered anymore, but I still find myself buying items to hide under. Again, precaution has become ingrained.

Bed

The tentacles extend further. Years of self harm has skewed my perspective on a number of things. For instance, if you accidentally injure yourself I am the best and worst person to ask for help. I’ll definitely give top notch wound care advice. I know what dressing you need and how to clean every gash. I’ll also almost always think you’re making a fuss of nothing. I’ll probably think you can manage without medical assistance unless your leg is hanging off. When you cry or complain about the pain, I will be outwardly kind, but inside, I think you should cowboy up. Your call an ambulance is my stick a plaster on it. I know I’m wrong, but that’s how my mind works. Furthermore any accidental injury that anyone ever tells me about will arouse my suspicion. Same deal for most scars. I spent years lying about cuts and breaks and burns. I have concocted excuses of every kind. No matter how plausible your story I will have a moments doubt. It’s no reflection on you. I know you didn’t do it to yourself. It’s just that I also know that people lie. I lied. To everyone. Repeatedly. Habitually. For a very long time. It warped my thought process. Oh and if I have an accident I spend a lot of time carefully crafting how I will explain it. My head’s first assumption is that everyone shares my doubts. I’m always scared that someone will think I’ve fallen off the recovery wagon. Logic kicks in and throws the crazy out, but there’s a delay.

Black toe nails & tattoos

I never answer the door in short sleeves. Everyone knows they can’t just drop by my house. In the past I didn’t know if myself or my home would be fit for visitors. The anxiety of unexpected guests lives on even if the pools of blood do not. My first aid tin is always extensively stocked. I still can’t go anywhere without a cover up. My days of hiding every scar are gone, but my brain needs to know I have the option.

Blood transfusion

Watching cinematic portrayals of gore annoys the hell out me. I know that slash wouldn’t produce so much blood. Blood doesn’t stay wet that long. Cutting your wrists is nowhere as easy as films would have you believe. Cold water and salt is how you remove a blood stain. Rotting blood smells a bit fishy. A troponin test will determine if you’re having an actual heart attack. Stitches in the stomach don’t really hurt, don’t bother with local. The body takes 4-6 weeks to replace the red cells when blood is lost. Drs will usually insist on an transfusion when haemoglobin drops below 7 g/dl. Learning the topology of Langer’s lines allows for cuts to be made in the correct direction to reduce scarring. Inadine patches will prevent infection. Anti bacterial gel stops scars from itching. Scalpel blades can be bought in art stores. Ice can burn. Arterial blood pulses. My brain clings to all of this and more. Information, dictums & routines that no longer serve purpose, but retain a hold. That nurse was more right than she could ever imagine. Yup, self harm leaves one hell of a mark.

Most of the time…

I haven’t cut myself for a long time. Realistically speaking, I cannot ever cut myself again. They call this recovery. Apparently, I’m recovered. I just don’t always feel it.

Tonight I looked through my old self harm pictures. Yes, I have pictures. When I was in the thick of it I always took photographs. Firstly because I felt compelled to, it was part of my ritual. Also, because I couldn’t trust myself to judge the severity of my wounds. Those pictures gave me the tiny bit of distance required to see what level of medical intervention I could get away with. Now, they’re a stop gap.

They’re the thing I do when I want to cut so badly it hurts not to. I look at those images of gore & miss it.

I miss the blood. The hot, flowing, staining everything I own blood.

I miss the smell & that crackling sound my skin makes when I slice into scar tissue.

I want the pain. I want the deep, sharp trauma my blade inflicts & the hot throb of infected tissue. I long for the ache of putting a butchered arm into a sleeve.

I know that doesn’t make any sense. I know it’s sick & crazy. It is still true. There’s a reason I yearn for the carnage; it works. Only briefly and, sure, it also fucks up your life, but those moments of respite are everything. Physical pain is nothing compared to the relentless agony that can exist in my head. Most of the time it’s manageable. Most of the time I can make it sleep. Most of the time I’m in control. Control isn’t easy. It is work. Exhausting, consuming labour.

The blade is easier. In the short term it’s beautiful relief. All those horrific feelings pour out with the blood. I can slash through my anguish just as easy I hack through my flesh. That’s why we do it. In case you were wondering. The reason some us do insane things to ourselves is because it’s effective. We hurt ourselves to heal ourselves.

The calm just doesn’t last very long. The sickness comes back. It returns stronger every time. The crazy grows. You need bigger, deeper, scarier cuts to keep it quiet. Then the self harm becomes a crazy of its own. You need it. You find yourself listening to drs who say you’re going to die. And even though you really don’t want to die. It’s hard to care. Now the crazy is trying to destroy you & the cutting is competing to do you in first.

So, I don’t cut anymore. I can’t cut anymore because I cannot control it.

If I want to be in charge,

If I want a chance at living a life I love,

If I want to not hurt everyone who cares about me,

I can’t cut.

Sometimes, though, I desperately want to. The easy way out looks good. The horror movie in my head wants to come to life, but I can’t let it. I don’t cut.

I just look at old pictures

And

Write all the things I can’t bring myself to say out loud.

I don’t cut anymore & most of the time I’m glad.

Wake me up inside…

Today I saw another one of those social media that purports to offer alternatives to self harm. This time the post also claimed that sharing this information would save lives.

I’m just going to be completely honest, this bull isn’t saving any lives. These are not credible alternatives to self harm. They will not stop an ill person from hurting themselves. They don’t solve the problem of why a person might feel the need to hurt themselves; they don’t even address it. In fact, in some cases they reaffirm the idea that hurting yourself is a good coping mechanism (just so long as you do it in a socially acceptable manner).

I’ve talked & written about why these suggestions are insulting until i’m blue in the face. I see others giving excellent arguments against such advice & yet this sort of thing is still the only information disseminated in the mainstream. So, I thought I’d try to talk about what actually can help one refrain from hurting oneself.

My suggestions are more complicated & time consuming & bloody hard. They don’t lend themselves to becoming a jaunty list to share in Twitter. The grim reality is that self harm is a grind and so is quitting.

Blood stained foot

For me the first step in getting anywhere close to stopping was understanding why I started in the first place. I truly believe understanding why a person self harms is crucial to recovery. Self harm isn’t the illness, it’s a symptom of it. From the outside identifying what is distressing you might seem simple, but trust me, it isn’t. There can be layers of trauma & hurt. A person may have a lifetime of issues woven into a complex fabric of pathologies. Picking that apart is intensely painful. Having pulled on that dangerous thread, you’re going to have to find ways address those underlying problems. They don’t simply disappear under a bright light. It takes time, professional guidance & huge bravery.

And that’s just the beginning. Next you have discern what you get from self harm; how is it helping you cope. What function is inflicting pain serving. Again, this is no simple puzzle to solve. My self harm had many roles. I was punishing myself, I hated the body that had failed me, I was avoiding emotions I couldn’t cope with, the blood was cathartic, I became addicted & a multitude of other reasons. Predictably totting up all the pay offs doesn’t negate them. There is more work to be done. One must weigh how healthy each function is and decide if it enhances ones life. For instance, probably not a great idea to be continually forcing myself to do penance, however it is a good idea to not be completely overwhelmed by sadness. You must find away to live without the unhealthy whilst also establishing new mechanisms to maintain essential uses. Of course all the time you are working away at your inner self you are dealing with addiction. Self harm is habit forming. So, your journey of self discovery/healing/madness has a background of overwhelming urges & powerful compulsions. To begin with you have to fight the full force of addiction every single moment of every single day. Plus, of course, everyone has their own additional problems to throw into the mix. Maybe you have co morbidities or financial problems or a family you’re trying not mess up with your illness. Life doesn’t stop when crazy calls.

None of this easy. It does not and cannot happen over night. It involves breaking down long held beliefs & opening yourself up to being scared and vulnerable. This post is just a simplified version of a process that takes years. It involves psychiatric professionals, medical intervention, medication, therapy, a support network, a&e visits & most of all trying to be honest. I understand why it’s easier to pretend you can draw on your skin or scream at a wall until you’re better. It is terrifying to a/ begin trying access the kind of intensive help needed & b/ expose yourself to pain you’ve been desperately trying to suppress. Believe me, selling yourself & others a lie is not the answer.

The truth is there are no tips & tricks for beating self harm. There is no magic fix or complete cure. I look at it like any other addiction. I will probably always want to cut, I have to do whatever I can not to. No amount of extremely cold water will ever change that harsh fact. When it comes right down to it, for me, the driving force in abstaining is knowing that I want other things more than I want to pick up that scalpel. Oh & sheer will power. I couldn’t have come to that realisation without more than a decade of therapy. I absolutely could never have exercised this level of control over the voice in my own head without putting in all that work.

I’m not going to say everyone’s story is the same as mine. I can’t guarantee that you can ever get completely better. I’m not. I can only offer you the hard truth of my experience & my certainty that there aren’t any shortcuts. Don’t share false hope. Let’s be honest with people who really need it. Trying to quit self harm is a nightmare, but there is hope that you’ll wake up.

Don’t tell me what to do…

In this world of self care & mindfulness it seems like everyone thinks they’re a therapist. Don’t get me wrong, sharing what works for you & talking about our mental health is great. It’s just that, to put it bluntly, some people talk crap. Others just regurgitate tired old advice that ain’t helping anyone. Man alive, I’m sick of it.

I want to talk specifically about the useless chatter surrounding self harm. I’ve been hearing & seeing the same patronising advice for YEARS. The most frustrating part is it often comes from people who really should know better. So, allow me to take you through why so much of the standard advice is just plain bad.

1/ Draw on your skin instead of cutting/burning etc.

This one usually takes two forms. The first opines that whatever relief/release a person may find in hurting themselves they can also attain by simply drawing on their skin. Now, let me ask you this, if drawing lines on yourself would make you feel better would you be causing physical trauma in the first place? The answer is of course, no. The components of self harm that serve a purpose vary, it may be pain, blood, disfiguring the skin or even a need to punish oneself. None of which needs are met by drawing.

The second part of the draw on your skin nonsense is the idea that you draw something pretty (often a butterfly) where you would normally self harm. The desire to preserve the ‘body art’ is then supposed to dissuade a person from ‘spoiling’ their skin. The stupidity of this idea is obvious. If actually scarring oneself will not prevent a person from harming themselves it seems very unlikely that spoiling a temporary drawing will. Even if by some miracle a biro butterfly were enough to assuage overwhelming distress, the body has a lot of flesh. Are people to cover every inch of themselves in rainbows & roses?

Butterfly drawn on skin

2/ Have a hot bath, cup of tea, blah, blah, blah…

Imagine the kind of agony you would have to be in to take a scalpel to yourself & cut for hours. Do you think a nice bath would magic that away? The answer is no. A bath helps you feel better at the end of tiring day. It does not release you from excruciating emotional pain.

3/ Distract yourself.

The need to self harm is powerful & persistent. For some reason lots of people (both professional & laymen) believe the urge is fleeting. I often see those struggling told to distract themselves until the urge passes. This advice betrays an ignorance regarding the workings of self harm. The need to hurt oneself does not easily wane. In fact, the longer a person self harms the stronger the compulsion becomes. Often it is impossible to focus on anything else. No sleeping or eating or thinking until the hunger to hurt is sated. It isn’t possible to distract oneself from that level of intrusion. When you cannot function on the most basic of levels watching a film or phoning friend are not options.

4/ Throw away your self harm tools.

The rationale here being that if one does not have the apparatus used to self harm, then self harm is impossible. WRONG.

As already discussed the compulsion to injure oneself is incredibly strong. Desperate people become ingenious. Trust me, when you really need to, you can hurt yourself with anything. Believe me again when I say those fraught & frenzied moments are when people make mistakes. As incomprehensible as it sounds self harm can be the very thing keeping someone alive. Asking or obligating an ill person to give up their lifeline is dangerous. It is also cruel.

5/ Ping your wrist with an elastic band/hols an ice cube in your hand etc.

My objections to this one are again two fold. To begin with it’s just ineffective. Self harm is both a habit firming & escalating problem. A person almost always experiences a need to increase the severity of their injurious behaviour. This takes us right back to the start. If the nip of an elastic band were sufficient, no one would be putting themselves in hospital via self harm.

A more serious objection, though, is the message this sends. Telling a vulnerable person that hurting themselves is ok, is a head fuck of massive proportions. Self harm is never the real problem, it is a symptom. In order to tackle self harm one must deal with the underlying issues. That is hard work, time consuming work. It’s much easier just to counsel harm minimisation. In doing so, you validate a sick person’s maladaptive thought process. That mental health professionals routinely tell patients that hurting themselves is ok is a disgrace. The basic premise of the hold an ice cube/ping an elastic band technique is that hurting yourself is a reasonable response to emotional turmoil. Just don’t do it badly enough to bother other people. By suggesting someone harm themselves in a small way you have shifted the conversation from, ‘let’s help you not hurt yourself’ to ‘hurt yourself in ways that do not draw attention to the act’. It is ignoring the root of the problem & allowing a person to believe that they are deserving of pain. It’s lazy, it counter productive & it is bullshit.

Hand holding ice

If you are struggling with self harm or you know someone who is, don’t feel helpless. When you are searching for help & find only these sort of suggestions it can feel like there are no answers. Whilst there are no quick fixes, there is hope.

See your Gp. If they don’t listen or offer help, see another Gp. I know this is exhausting at a time when you can least afford a fight, but please, don’t give up. If you have a friend or family member who can be your advocate, take them with you. You deserve treatment. You deserve care.

If you have badly injured yourself please seek medical advice. Again, if you have a friend or family member who can support you, take them along. If you do not & are worried about how you will be treated taking a copy of NHS NICE GUIDELINES can be helpful. You are entitled to be treated with the same compassion & respect as any other patient. Most emergency personnel will do this, but a few may need reminding of their duty. Being able to quote these guidelines helps in such situations. As scary as this may sound, do not put yourself at risk by avoiding treatment. You are worthy of diligent medical care.

If you are not yet ready or able to see a Dr, you can contact The Samaritans 24/7.

Call – 116 123 (uk)

Email – jo@samaritans.org